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Primary versus staged repair for tetralogy of Fallot in symptomatic neonates: systematic review and meta-analysis

Published online by Cambridge University Press:  24 October 2024

Pribadi W. Busro Open the ORCID record for Pribadi W. Busro [Opens in a new window] ,
Raymen Satria Open the ORCID record for Raymen Satria [Opens in a new window] ,
Safitri Safitri ,
Adrian R. Sudirman ,
Muhammad R. Bachmid ,
Dwi G. Fardhani ,
Stefanus Nursalim ,
Matthew Billy  and
Renaldi Prasetio
Pribadi W. Busro*
Affiliation:
Cardiothoracic and Vascular Surgery Division, Department of Surgery, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia Pediatric and Congenital Heart Surgery Department, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
Raymen Satria
Affiliation:
Cardiothoracic and Vascular Surgery Division, Department of Surgery, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
Safitri Safitri
Affiliation:
Cardiothoracic and Vascular Surgery Division, Department of Surgery, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
Adrian R. Sudirman
Affiliation:
Cardiothoracic and Vascular Surgery Division, Department of Surgery, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
Muhammad R. Bachmid
Affiliation:
Cardiothoracic and Vascular Surgery Division, Department of Surgery, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
Dwi G. Fardhani
Affiliation:
Cardiothoracic and Vascular Surgery Division, Department of Surgery, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
Stefanus Nursalim
Affiliation:
Cardiothoracic and Vascular Surgery Division, Department of Surgery, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
Matthew Billy
Affiliation:
Cardiothoracic and Vascular Surgery Division, Department of Surgery, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
Renaldi Prasetio
Affiliation:
Cardiothoracic and Vascular Surgery Division, Department of Surgery, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
*
Corresponding author: Pribadi W. Busro; Email: [email protected]
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Abstract

The choice between primary repair and staged repair strategy for Tetralogy of Fallot remains a subject of debate in clinical practice. This review aims to compare the outcomes and efficacy of two surgical approaches in managing Tetralogy of Fallot among neonatal populations. Literature search was conducted across seven databases, identifying a total of 1393 relevant studies. Inclusion criteria encompassed comparative studies focusing on primary repair and staged repair for Tetralogy of Fallot in neonates. Quality of included studies was assessed using The Newcastle-Ottawa Scale for retrospective cohort studies. Data synthesis involved the extraction of post-operative outcomes. Meta-analysis was performed where feasible, pooling effect sizes to determine the overall impact of each repair strategy. Eight studies were selected for full-text appraisal. A total of 4464 Tetralogy of Fallot patients underwent surgical correction. The pooled mean patient age was 8.68 (±7.38) and 8.56 (±6.8) days for primary repair and staged repair, respectively. The primary repair was associated with a higher cardiac complications rate (odds ratio 1.50, 95% confidence interval 1.07 to 2.10) and transannular patch usage (odds ratio 2.62, 95% CI confidence interval 2.02 to 3.40). In contrast, staged repair was associated with longer hospital (mean difference 11.84, 95% confidence interval 9.59 to 14.10) and ICU (mean difference 3.06, 95% confidence interval 1.64 to 4.47) length of stay. However, no substantial differences were observed in terms of mortality and reintervention rates between these two approaches. The findings highlight the need for well-designed research and emphasise the importance of personalised approaches to address the intricate nature of Tetralogy of Fallot management in this population. Adjusting surgical approach to patient features may be necessary to maximise surgical outcomes.

Keywords

neonatesoutcomesprimary repairstaged repairTetralogy of Fallot
Type
Original Article
Information
Cardiology in the Young , Volume 34 , Issue 10 , October 2024 , pp. 2156 - 2163
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Copyright
© The Author(s), 2024. Published by Cambridge University Press

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