Mortality Risk Factors in Tetralogy of Fallot Patients Undergoing Total Correction

A total correction is a preferred treatment for Tetralogy of Fallot patients in every part of the world. However, the mortality in developing countries was as high as 6.9% to 15.3%. This was a retrospective analytic study that analyzed pre and post-operative risk factors that affected mortality on TOF patients that were performed total correction in Indonesia. A total of 47 TOF patients that were performed total correction from January 2016 to September 2019 were enrolled in this study based on the inclusion criteria. Preoperative and post-operative data were obtained from medical records. In this research, the majority of mortality was found in male patients (39.3%), while the female’s rate was lower (36.8%). Overall mortality was 38.3% and one operative death was found. The average age of patients was 84.12 months (12-210 months), whereas the average height (85.56 ± 36.17cm vs. 112.93 ± 21.73) and weight (17.22kg vs. 28.21kg) were lower for mortality patients. Some significant preoperative variables were identified as mortality risk factors such as: age below 60 months (p=0.047), smaller weight and height (p=0.008; p=0.002), abnormal hematocrit (p=0.002), and oxygen saturation below 75% (p=0.018). Significant post-operative risk factors included: temperature above 38.5⁰C (p=0.000), and ventilator time of more than 48 hours (p=0.033). In conclusion, the mortality of TOF patients undergoing a total correction in developing countries was quite high. It was associated with some risk factors, such as younger age, lower weight and height, low oxygen saturation, post-operative fever, and prolonged ventilator time.

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Total Correction of Tetralogy of Fallot in the First 60 Days of Life in Symptomatic Infants: Is It The Gold Standard?

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0039-1678698 ◽

2019 ◽

Vol 68 (01) ◽

pp. 045-050 ◽

Cited By ~ 2

Author(s):

Yasser Menaissy ◽

Ihab Omar ◽

Basem Mofreh ◽

Mohamed Alassal

Keyword(s):

Risk Factors ◽

Body Weight ◽

Tetralogy Of Fallot ◽

Gold Standard ◽

Pulmonary Arteries ◽

Total Correction ◽

Term Survival ◽

Surgical Risk ◽

Collateral Arteries ◽

The Mean

Background The timing of surgical repair of tetralogy of Fallot (TOF) is a key to alleviate complications and for long-term survival. Total correction was usually performed at the age of 6 months or older under the notion of decreasing the surgical risk. However, avoiding palliation with an aortopulmonary shunt and early correction of systemic hypoxia appear to be of more benefit than the inborn surgical risk in low body weight patients. Our objective was to assess early/midterm survival and operative complications and to analyze patients, surgical techniques, and morphological risk factors to determine their effects on outcomes. Patients and Methods We retrospectively reviewed 152 patients with TOF who were ≤60 days of age when they underwent total correction of TOF. All patients had either duct-dependent pulmonary blood flow or arterial blood oxygen saturation less than 65% on room air requiring urgent surgical correction. Exclusion criteria included TOF with pulmonary atresia, TOF with nonconfluent pulmonary arteries, TOF with multiple aortopulmonary collateral arteries, and associated complete atrioventricular septal defects. Results The mean age at repair was 34 ± 19 days, and the mean weight was 3.8 ± 0.9 kg. Before surgery, 96 patients received an infusion of prostaglandin, 45 were mechanically ventilated, and 32 required inotropic support. Right ventricular outflow tract obstruction was managed with a transannular patch in 112 patients, and all the others had a main pulmonary artery patch. Cardiopulmonary bypass (CPB) with moderate hypothermia was the standard, and the CPB time averaged 48 ± 21 minutes. The postoperative intensive care unit stay was 5.7 ± 6 days, with 2.8 ± 4 days of mechanical ventilation. Early mortality was 4.6% (7 of 152), and actuarial survival rates were 95% at 1 year and 92% at 5 years. Univariable and multivariable analyses of the patients' demographics, anatomical characteristics, and operative techniques revealed the presence of small pulmonary arteries and low body weight to be the only independent risk factors for death. Conclusion Early total correction of TOF during the first 60 days of life can be performed with low mortality and good intermediate-term survival and, from our point of view, “should be the gold standard for TOFs.”

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Relationships between hyperinsulinaemia, magnesium, vitamin D, thrombosis and COVID-19: rationale for clinical management

Open Heart ◽

10.1136/openhrt-2020-001356 ◽

2020 ◽

Vol 7 (2) ◽

pp. e001356 ◽

Cited By ~ 1

Author(s):

Isabella D Cooper ◽

Catherine A P Crofts ◽

James J DiNicolantonio ◽

Aseem Malhotra ◽

Bradley Elliott ◽

...

Keyword(s):

Risk Factors ◽

Vitamin D ◽

Oxygen Saturation ◽

Carbon Dioxide Production ◽

Common Denominator ◽

Low Oxygen ◽

Cholesterol Sulfate ◽

Magnesium Depletion ◽

Thrombosis Risk ◽

Saturation Capacity

Risk factors for COVID-19 patients with poorer outcomes include pre-existing conditions: obesity, type 2 diabetes mellitus, cardiovascular disease (CVD), heart failure, hypertension, low oxygen saturation capacity, cancer, elevated: ferritin, C reactive protein (CRP) and D-dimer. A common denominator, hyperinsulinaemia, provides a plausible mechanism of action, underlying CVD, hypertension and strokes, all conditions typified with thrombi. The underlying science provides a theoretical management algorithm for the frontline practitioners.Vitamin D activation requires magnesium. Hyperinsulinaemia promotes: magnesium depletion via increased renal excretion, reduced intracellular levels, lowers vitamin D status via sequestration into adipocytes and hydroxylation activation inhibition. Hyperinsulinaemia mediates thrombi development via: fibrinolysis inhibition, anticoagulation production dysregulation, increasing reactive oxygen species, decreased antioxidant capacity via nicotinamide adenine dinucleotide depletion, haem oxidation and catabolism, producing carbon monoxide, increasing deep vein thrombosis risk and pulmonary emboli. Increased haem-synthesis demand upregulates carbon dioxide production, decreasing oxygen saturation capacity. Hyperinsulinaemia decreases cholesterol sulfurylation to cholesterol sulfate, as low vitamin D regulation due to magnesium depletion and/or vitamin D sequestration and/or diminished activation capacity decreases sulfotransferase enzyme SULT2B1b activity, consequently decreasing plasma membrane negative charge between red blood cells, platelets and endothelial cells, thus increasing agglutination and thrombosis.Patients with COVID-19 admitted with hyperglycaemia and/or hyperinsulinaemia should be placed on a restricted refined carbohydrate diet, with limited use of intravenous dextrose solutions. Degree/level of restriction is determined by serial testing of blood glucose, insulin and ketones. Supplemental magnesium, vitamin D and zinc should be administered. By implementing refined carbohydrate restriction, three primary risk factors, hyperinsulinaemia, hyperglycaemia and hypertension, that increase inflammation, coagulation and thrombosis risk are rapidly managed.

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Mortality risk factors in premature infants with respiratory distress syndrome treated by mechanical ventilation

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh0502029f ◽

2005 ◽

Vol 133 (1-2) ◽

pp. 29-35 ◽

Cited By ~ 6

Author(s):

Dusko Fidanovski ◽

Vladislav Milev ◽

Aleksandar Sajkovski ◽

Antoni Hristovski ◽

Aspasija Sofijanova ◽

...

Keyword(s):

Risk Factors ◽

Mechanical Ventilation ◽

Developing Countries ◽

Birth Weight ◽

Mortality Rate ◽

Premature Infants ◽

Mortality Risk ◽

Newborn Infants ◽

Risk Of Mortality ◽

Maternity Hospitals

Respiratory distress syndrome (RDS) is the most common cause of respiratory failure and requirement for mechanical ventilation (MV) of newborns. RDS is also common cause of mortality and severe morbidity in premature infants. In developing countries, despite facilities for respiratory care of newborn infants, RDS mortality rate and percentage of complications still remain high in comparison to the developed countries. Survival rates of RDS infants requiring MV ranged from 25% in those newborns with birth weight <1000 grams up to 53% in those with birth weight >2500 grams. There have been limited data about causes of high mortality rate in infants with RDS from developing countries. AIM The objectives of the study were to determine (I) the incidence of severe RDS at Pediatric Intensive Care Unit (PICU), University Children's Hospital Skopje (UCHS) and main characteristics of infants with RDS, as well as (II) the survival rate and mortality risk factors of these infants. MATERIAL AND METHODS The study included 126 premature infants with clinical and radiological signs of RDS requiring mechanical ventilation who were admitted to PICU, UCHS between January 1996 and December 2003. The mean gestational age (GA) of the infants was 31.5+2.5 weeks, and the mean birth weight (BW) was 1663+489 grams. The management of newborns with RDS at PICU, UCHS, follows the standard protocol, with emphasis on minimal manipulation, maintenance of thermo neutral environment, administration of humidified oxygen and non-invasive cardio respiratory monitoring. Pressure-limited time-cycled mechanical ventilation with pediatric/neonatal ventilators was performed in all infants. In those newborn infants with clinical and radiological signs of RDS and need for MV with FiO2>0.4, synthetic (Exosurf) or natural (Survanta) surfactants were administered. Out of all newborns, 43 infants (34%) were not treated with surfactant, because it was not available at that time. RESULTS In the period 1996-2003, out of 1722 consecutive admissions to PICU, 693 hospitalized infants had neonatal RDS (40.2%). A total of 210 (30.3%) infants with RDS required intubation and PPV, and 126 met the inclusion criteria for this study. Surfactant replacement therapy (up to two doses) was given to 83 (65.8%) infants. Most of neonates (80 or 634%) were born at two maternity hospitals in Skopje, and others were transferred from regional maternity hospitals in Macedonia. The relation between perinatal characteristics, disease severity and outcome was illustrated in Table 2. There was higher risk of mortality in infants with lower birth weight, lower Apgar score (minutes 1 and 5), and shorter gestational age. Expected admission values of VI as well as other parameters of illness severity were not significantly associated with higher risk of mortality. The newborns with air-leak sy (any form) and pulmonary hemorrhage had significantly higher risk of dying, while the risk of mortality was significantly lower in infants with sepsis and BPD as complications in studied cohort. The findings of logistic regression analysis for mortality risk factors were presented in Table 3. The minimal model identified a number of factors as independently associated with significantly higher risk of mortality. Infant birth weight ?1500 grams, admission VI ?0.2 mmHg and air leak sy (any form) as complication significantly increased the risk of dying in infants with RDS. BPD was significantly associated with survival in studied cohort. CONCLUSION In spite of the implementation of high technology in Neonatal Intensive Care in our country, the mortality rate of the infants with RDS is high, but is not different from that in developing countries. The improvement of perinatal care and diminution of risk factors, common use of surfactant as well as antenatal steroids could most probably result in better outcome of neonatal RDS.

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Morphologic change of pulmonary arteries and right ventricular outflow tract after total correction of tetralogy of Fallot: risk factors for pulmonary artery junctional stenosis

Korean Circulation Journal ◽

10.4070/kcj.2001.31.2.238 ◽

2001 ◽

Vol 31 (2) ◽

pp. 238

Author(s):

Jin Sung Ko ◽

Jae Young Choi ◽

Jong Kyun Lee ◽

Kyung Eun Kim ◽

Jun Hee Sul ◽

...

Keyword(s):

Risk Factors ◽

Pulmonary Artery ◽

Right Ventricular ◽

Tetralogy Of Fallot ◽

Pulmonary Arteries ◽

Right Ventricular Outflow Tract ◽

Ventricular Outflow Tract ◽

Outflow Tract ◽

Morphologic Change ◽

Total Correction

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Tetralogy of Fallot with unilateral absent pulmonary artery

Cardiology in the Young ◽

10.1017/s1047951112000911 ◽

2012 ◽

Vol 23 (3) ◽

pp. 423-430 ◽

Cited By ~ 2

Author(s):

Murat Ugurlucan ◽

Ahmet H. Arslan ◽

Yahya Yildiz ◽

Sibel Ay ◽

Resmiye T. Besikci ◽

...

Keyword(s):

Pulmonary Artery ◽

Tetralogy Of Fallot ◽

Treatment Protocol ◽

Haemodynamic Instability ◽

Low Oxygen ◽

Total Correction ◽

Mortality And Morbidity ◽

Congenital Cardiac Malformation ◽

Shunt Procedure ◽

Absent Pulmonary Artery

AbstractBackgroundTetralogy of Fallot is a common congenital cardiac malformation. A rare subgroup includes unilateral absence of the pulmonary artery, either the left or the right main branch. The literature lacks an established treatment for these cases, and surgical options carry certain mortality and morbidity.Patients and methodsThere were five patients who had single pulmonary artery and received surgical treatment among the 126 patients with the diagnosis of Tetralogy of Fallot, who were admitted to our institution between July, 2010 and November, 2011. All the patients were male. Ages ranged between 12 months and 8 years. The mean body mass index was 17.1 plus or minus 3.4 kilograms per square metre. Pulmonary artery Nakata index, Nakata index Z-score, and the McGoon index were used for the quantitative assessment of the pulmonary artery and to determine the surgical strategy.ResultsUrgent modified Blalock–Taussig shunt operations were performed in two patients with very low oxygen saturation and haemodynamic instability. These patients are scheduled for corrective procedures on an elective basis. There was one patient who received an elective shunt procedure; however, the post-operative course was complicated with the overflow phenomenon and the patient underwent total correction with a check-valved patch used to close the ventricular septal defect. The patient required extracorporeal membrane oxygenator support in the post-operative period. There were two patients who underwent total correction of the pathology uneventfully. Mortality did not occur. Mean durations of hospital stay and follow-up were 14 plus or minus 13.4 days and 184.5 plus or minus 89.3 days, respectively.ConclusionOur modest series with Tetralogy of Fallot with unilateral absent pulmonary artery indicates the feasibility of surgical correction in patients with appropriate unilateral pulmonary artery size and palliative procedures when the pulmonary artery size is smaller than that predicted for the age. Multi-centre long-term data of larger series are warranted in order to establish a treatment protocol.

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Risk Factors for SARS-CoV-2 Infection Severity in Abu Dhabi

Journal of Epidemiology and Global Health ◽

10.1007/s44197-021-00006-4 ◽

2021 ◽

Vol 11 (4) ◽

pp. 344-353

Author(s):

Latifa Mohammad Baynouna AlKetbi ◽

Nico Nagelkerke ◽

Hanan Abdelbaqi ◽

Fatima ALBlooshi ◽

Mariam AlSaedi ◽

...

Keyword(s):

Physical Activity ◽

Risk Factors ◽

Logistic Regression ◽

Mortality Rate ◽

Oxygen Saturation ◽

Severe Disease ◽

Older Age ◽

Abu Dhabi ◽

Complex Care ◽

Low Oxygen

Abstract Background Prediction models are essential for informing screening, assessing prognosis, and examining options for treatment. This study aimed to assess the risk of SARS-CoV-2 infection severity in the Abu Dhabi population. Methods This is a mixed retrospective cohort study and case–control study to explore the associated factors of receiving treatment in the community, being hospitalized, or requiring complex hospital care among patients with a diagnosis of SARS-CoV-2. Of 641 patients included, 266 were hospitalized; 135 were hospitalized and either died or required complex care, i.e., required ICU admission, intubation, or oxygen and 131 did not develop severe disease requiring complex care. The third group (“controls”) were 375 patients who were not hospitalized. Logistic regression analyses were used to study predictors of disease severity. Results Among hospitalized patients older age and low oxygen saturation at admission were the consistent and strongest predictors of an adverse outcome. Risk factors for the death in addition to age and low oxygen saturation were elevated white blood count and low reported physical activity. Chronic kidney disease and diabetes were also associated with more severe disease in logistic regression. The mortality rate among those with less than 30 min per week of physical activity was 4.9%, while the mortality rate was 0.35% for those with physical activity > 30 min at least once a week. The interval from the onset of symptoms to admission and mortality was found to have a significant inverse relationship, with worse survival for shorter intervals. Conclusion Oxygen saturation is an important measure that should be introduced at screening sites and used in the risk assessment of patients with SARS-CoV-2. In addition, an older age was a consistent factor in all adverse outcomes, and other factors, such as low physical activity, elevated WBC, CKD, and DM, were also identified as risk factors.

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Assessment of risk factors for early mortality after total correction of Tetralogy of Fallot

Archives de Pédiatrie ◽

10.1016/0929-693x(96)87109-0 ◽

1996 ◽

Vol 3 (7) ◽

pp. 735

Author(s):

A.Y. De Voogd ◽

W.A. Helbing ◽

M.G. Hazekamp ◽

J. Otterkamp

Keyword(s):

Risk Factors ◽

Tetralogy Of Fallot ◽

Early Mortality ◽

Total Correction

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Studying the Birth Outcome in Tikrit Teaching Hospital

International Journal of Medical Sciences ◽

10.32441/ijms.v1i1.43 ◽

2018 ◽

Vol 1 (1) ◽

pp. 55-57

Author(s):

Areej Noaman

Keyword(s):

Risk Factors ◽

Developing Countries ◽

Teaching Hospital ◽

Birth Outcome ◽

Morbidity And Mortality ◽

Healthy Baby ◽

Factors Affecting ◽

Neonatal Deaths ◽

Healthy Mother

Background : A successful birth outcome is defined as the birth of a healthy baby to a healthy mother. While relatively low in industrialized world, maternal and fetal morbidity and mortality and neonatal deaths occur disproportionately in developing countries. Aim of the Study: To assess birth outcome and identify some risk factors affecting it for achieving favorable birth outcome in Tikrit Teaching Hospital

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