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Survey of multinational surgical management practices in tetralogy of Fallot

Published online by Cambridge University Press:  04 December 2018

Sara Hussain ,
Osman Al-Radi ,
Tae-Jin Yun ,
Zhongdong Hua ,
Budi Rahmat ,
Suresh Rao ,
An Qi ,
Charles Fraser ,
Yves d’Udekem  and
Quazi Ibrahim
...Show all authors
Sara Hussain
Affiliation:
Division of Cardiovascular Surgery, Hospital for Sick Children, Toronto, ON, Canada
Osman Al-Radi
Affiliation:
Division of Cardiovascular Surgery, King Abdulaziz University, Jeddah, Saudi Arabia
Tae-Jin Yun
Affiliation:
Division of Cardiovascular Surgery, Asan Medical Center, Seoul, South Korea
Zhongdong Hua
Affiliation:
Division of Cardiovascular Surgery, Beijing Fuwei Hospital, Beijing, China
Budi Rahmat
Affiliation:
Division of Cardiovascular Surgery, National Cardiovascular Centre Harapan Kita, Jakarta, Indonesia
Suresh Rao
Affiliation:
Division of Cardiovascular Surgery, Kokilaben Dhirubhai Ambani Hospital & Medical Research Institute, Mumbai, India
An Qi
Affiliation:
Division of Cardiovascular Surgery, West China Hospital, Chengdu, China
Charles Fraser
Affiliation:
Department of Congenital Heart Surgery, Texas Children’s Hospital, Houston, TX, USA
Yves d’Udekem
Affiliation:
Cardiac Surgery Unit, Royal Children’s Hospital, Melbourne, Australia
Quazi Ibrahim
Affiliation:
Population Health Research Institute, Hamilton, ON, Canada
Ingrid Copland
Affiliation:
Population Health Research Institute, Hamilton, ON, Canada
Richard Whitlock
Affiliation:
Division of Cardiac Surgery, McMaster University/Population Health Research Institute, Hamilton, ON, Canada
Glen Van Arsdell*
Affiliation:
Division of Cardiovascular Surgery, Hospital for Sick Children, Toronto, ON, Canada
*
Author for correspondence: Dr Glen Van Arsdell, MD, The Hospital for Sick Children Room 1525-555 University Avenue, Toronto, ON, Canada M5G 1X8. Tel: +1 416 813 6420; Fax: +1 416 813 7984; E-mail: [email protected]
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Abstract

Background

A wide variety of surgical strategies are used in tetralogy of Fallot repair. We sought to describe the international contemporary practice patterns for surgical management of tetralogy of Fallot.

Methods

Surgeons from 18 international paediatric cardiac surgery centres (representing over 1800 tetralogy of Fallot cases/year) completed a Research Electronic Data Capture-based survey. Participating countries include: China (4), India (2), Nepal (1), Korea (1), Indonesia (1), Saudi Arabia (3), Japan (1), Turkey (1), Australia (1), United States of America (2), and Canada (1). Summary measures were reported as means and counts (percentages). Responses were weighted based on case volume/centre.

Results

Primary repair is the prevalent strategy (83%) with variation in age at elective repair (range). Approximately 47% of sites use patient age as a factor in determining the strategy, with age <3 months being the common cut-off for staged repair. In addition, patient weight of <3 kg is an indication for staged repair in 80% of participating institutions. Trans-atrial ventricular septal defect closure is the preferred approach in 62% of sites. Approximately 70% of responders reported using pulmonary valve z-score to guide right ventricular outflow tract management technique with the most prevalent cut-off for annulus preservation being a z-score of −3. Estimated incidence of annulus preservation is 53%. Minimal trans-annular incision is performed in >90% of all trans-annular repairs.

Conclusions

In this cohort representing 11 countries, there is variation in tetralogy of Fallot surgical management with no consensus on standard of practice. A large international prospective cohort study would allow analysis of impact of underlying anatomy and repair strategy on early and late outcomes.

Keywords

CHDtetralogy of Fallotsurvey
Type
Original Article
Information
Cardiology in the Young , Volume 29 , Issue 1 , January 2019 , pp. 67 - 70
Copyright
© Cambridge University Press 2018 

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Footnotes

Cite this article: Hussain S, Al-Radi O, Yun TJ, Hua Z, Rahmat B, Rao S, Qi A, Fraser C, d’Udekem Y, Ibrahim Q, Copland I, Whitlock R, Van Arsdell G (2018) Survey of multinational surgical management practices in tetralogy of Fallot. Cardiology in the Young29: 67–70. doi: 10.1017/S1047951118001932

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