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Tetralogy of Fallot: stent palliation or neonatal repair?

Part of: Tetralogy of Fallot (TOF) Echocardiography Surgery Interventional Cardiology

Published online by Cambridge University Press:  08 March 2021

Adeolu Banjoko ,
Golnoush Seyedzenouzi ,
James Ashton ,
Fatemeh Hedayat ,
Natalia N. Smith ,
Henry Nixon ,
Abdulla Tarmahomed ,
Amr Ashry  and
Amer Harky Open the ORCID record for Amer Harky [Opens in a new window]
Adeolu Banjoko
Affiliation:
College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
Golnoush Seyedzenouzi
Affiliation:
St. George’s University of London, Cranmer Terrace, London, UK
James Ashton
Affiliation:
School of Medicine, University of Liverpool, Cedar House, Ashton Street, Liverpool, UK
Fatemeh Hedayat
Affiliation:
School of Medicine and Dentistry, University of Central Lancashire, UK
Natalia N. Smith
Affiliation:
St. George’s University of London, Cranmer Terrace, London, UK
Henry Nixon
Affiliation:
St. George’s University of London, Cranmer Terrace, London, UK
Abdulla Tarmahomed
Affiliation:
Department of Paediatric Cardiology, Alder Hey Children’s Hospital, Liverpool, UK
Amr Ashry
Affiliation:
Department of Cardiac Surgery, Alder Hey Children Hospital, Liverpool, UK Department of Cardiothoracic Surgery, Assiut University Hospital, Assiut, Egypt
Amer Harky*
Affiliation:
Department of Cardiac Surgery, Alder Hey Children Hospital, Liverpool, UK Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, UK
*
Author for correspondence: Amer Harky, MSc, MRCS, Department of Cardiac Surgery, Alder Hey Children Hospital, Liverpool, UK. Tel: +44-151-228-4811. E-mail: [email protected]
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Abstract

Surgical repair of Tetralogy of Fallot has excellent outcomes, with over 90% of patients alive at 30 years. The ideal time for surgical repair is between 3 and 11 months of age. However, the symptomatic neonate with Tetralogy of Fallot may require earlier intervention: either a palliative intervention (right ventricular outflow tract stent, ductal stent, balloon pulmonary valvuloplasty, or Blalock-Taussig shunt) followed by a surgical repair later on, or a complete surgical repair in the neonatal period. Indications for palliation include prematurity, complex anatomy, small pulmonary artery size, and comorbidities. Given that outcomes after right ventricular outflow tract stent palliation are particularly promising – there is low mortality and morbidity, and consistently increased oxygen saturations and increased pulmonary artery z-scores – it is now considered the first-line palliative option. Disadvantages of right ventricular outflow tract stenting include increased cardiopulmonary bypass time at later repair and the stent preventing pulmonary valve preservation. However, neonatal surgical repair is associated with increased short-term complications and hospital length of stay compared to staged repair. Both staged repair and primary repair appear to have similar long-term mortality and morbidity, but more evidence is needed assessing long-term outcomes for right ventricular outflow tract stent palliation patients.

Keywords

Tetralogy of Fallotsurgical repairstentpalliationneonatal repair
Type
Original Article
Information
Cardiology in the Young , Volume 31 , Issue 10 , October 2021 , pp. 1658 - 1666
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Copyright
© The Author(s), 2021. Published by Cambridge University Press

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Footnotes

*

These authors equally contributed to the work.

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