scholarly journals Outcomes of Complete Surgical Repair Versus Palliative Intervention in Neonates with Tetralogy of Fallot

2021 ◽  
Author(s):  
Mohammed Hamzah ◽  
Hasan Othman ◽  
Krystel Chedid ◽  
Mohammed Alsabri ◽  
Ibrahim Qattea ◽  
...  
Keyword(s):  
Tetralogy Of Fallot ◽  
Resource Utilization ◽  
Surgical Repair ◽  
Chromosomal Anomalies ◽  
Median Cost ◽  
National Inpatient Sample ◽  
Pulmonary Shunt ◽  
Median Length ◽  
Cardiac Catheter ◽  
The Us

Background: Surgical management of symptomatic neonates with Tetralogy of Fallot (TOF) is controversial. Either primary surgical repair (EPSR) in neonates with TOF or a staged palliation with initial palliative intervention (PI). Aim: Compare outcomes of neonates with TOF who had EPSR and those who had PI. Materials and Methods: The study utilized the US National Inpatient Sample dataset for the years 2000 to 2018. Patients with EPSR and those with PI (aortic to pulmonary shunt or cardiac catheter palliative intervention) identified. Results: A total of 29,292 neonates with TOF were identified; of them 1726 neonates had EPSR, 4363 had PI. Hospital mortality was similar in both groups (PI 7.4% vs EPSR 8.0%, p = 0.41). Patient in the PI group had more comorbidities; chromosomal anomalies (PI 13.2% vs. ESPR 7.8%,  p < 0.001), prematurity (PI 15.1% vs. EPSR 10.4%,  p < 0.001), and low birth weight < 2500 grams (PI 15.4% vs. EPSR 10.3%,  p < 0.001). Median length of stay and median cost of hospitalization were significantly higher in the EPSR (25 days vs. 19 days, and $312,405 vs. $191,863, respectively,  p < 0.001). Conclusion: EPSR had similar mortality to PI but comes with a higher resource utilization and complications. If we include the cumulative morbidity and resource utilization associated with a two staged repair, EPSR could be proven as a better strategy in symptomatic neonates with TOF. A prospective superiority study on symptomatic neonates with TOF randomized to either ESPR or PI is needed to further answer this question.

The mental health burden in acne vulgaris and rosacea: an analysis of the US National Inpatient Sample

2019 ◽  
Vol 44 (7) ◽  
pp. 766-772 ◽  
Author(s):  
V. Singam ◽  
S. Rastogi ◽  
K. R. Patel ◽  
H. H. Lee ◽  
J. I. Silverberg
Keyword(s):  
Mental Health ◽  
Acne Vulgaris ◽  
National Inpatient Sample ◽  
Health Burden ◽  
The Us

Tetralogy of Fallot: stent palliation or neonatal repair?

2021 ◽  
pp. 1-9
Author(s):  
Adeolu Banjoko ◽  
Golnoush Seyedzenouzi ◽  
James Ashton ◽  
Fatemeh Hedayat ◽  
Natalia N. Smith ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Right Ventricular ◽  
Tetralogy Of Fallot ◽  
Surgical Repair ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Outflow Tract ◽  
Hospital Length Of Stay ◽  
Mortality And Morbidity

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.

Outcomes and Resource Use for Liver Transplantation in the US: Insights from the 2009‐2017 National Inpatient Sample

2021 ◽  
Author(s):  
Esteban Aguayo ◽  
Joseph Hadaya ◽  
Morcos Nakhla ◽  
Catherine G. Williamson ◽  
Vishal Dobaria ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Resource Use ◽  
National Inpatient Sample ◽  
The Us

Ablation of atrial tachyarrhythmias late after surgical repair of tetralogy of Fallot

2010 ◽  
Vol 21 (1) ◽  
pp. 31-38 ◽  
Author(s):  
Dan Raine ◽  
John O’Sullivan ◽  
Milind Chaudhari ◽  
Leslie Hamilton ◽  
Asif Hasan ◽  
...  
Keyword(s):  
Catheter Ablation ◽  
Tetralogy Of Fallot ◽  
Surgical Repair ◽  
Pulmonary Regurgitation ◽  
Clinical Problem ◽  
Guidance System ◽  
Computer Assisted ◽  
Atrial Tachyarrhythmias ◽  
Jude Medical ◽  
Repaired Tetralogy Of Fallot

AbstractBackgroundPatients with repaired tetralogy of Fallot may develop symptomatic and haemodynamic deterioration for many reasons such as arrhythmia, pulmonary regurgitation, and impairment in ventricular function. We describe a consecutive group of patients whose main clinical problem was atrial tachyarrhythmias.AimsTo describe the clinical outcome of atrial tachyarrhythmias occurring late after surgical repair of tetralogy of Fallot; to define the circuits/foci responsible for these atrial tachyarrhythmias; to evaluate the outcome of computer-assisted mapping and catheter ablation in this patient group.Methods and resultsConsecutive patients with surgically repaired tetralogy of Fallot and atrial tachyarrhythmias, who underwent catheter ablation between January, 2001 and June, 2007, were identified retrospectively from case records. Computer-assisted mapping was performed in all using either EnSite® (St Jude Medical Inc.) arrhythmia mapping and intra-cardiac catheter guidance system or CARTO™ (Biosense Webster Inc.) electroanatomical mapping systems. Ten patients (four males) with a median age of 39 plus or minus 8 years were studied. The total number of atrial tachyarrhythmias identified was 22 (six macro-reentrant, 16 micro-reentrant/focal). In nine patients, catheter ablation led to improvement in arrhythmia episodes and/or symptoms during follow-up of 41 plus or minus 20 months. Following ablation(s), five patients required pacing for pre-existing conduction disease and five needed further surgery for haemodynamic indications. All patients remained on anti-arrhythmic drugs.ConclusionsPatients with surgically repaired tetralogy of Fallot and atrial tachyarrhythmias typically have multiple arrhythmic circuits/foci arising from a scarred right atrium. Catheter ablation reduces arrhythmia frequency and improves symptoms. However, hybrid management is often required, comprising drugs, pacing, and further surgery tailored to the individual.

scholarly journals Feasibility and safety of on table extubation after corrective surgical repair of tetralogy of Fallot in a developing country: A case series

2015 ◽  
Vol 18 (2) ◽  
pp. 237 ◽  
Author(s):  
MohammadIrfan Akhtar ◽  
Mohammad Hamid ◽  
Anwar-Ul-Haq ◽  
Fauzia Minai ◽  
Naveed Rehman
Keyword(s):  
Developing Country ◽  
Tetralogy Of Fallot ◽  
Surgical Repair ◽  
Case Series

scholarly journals Regional Wall Motion and Abnormalities of Electrical Depolarization and Repolarization in Patients After Surgical Repair of Tetralogy of Fallot

Circulation ◽  
2001 ◽  
Vol 103 (12) ◽  
pp. 1669-1673 ◽  
Author(s):  
Michael Vogel ◽  
Julia Sponring ◽  
Seamus Cullen ◽  
John E. Deanfield ◽  
Andrew N. Redington
Keyword(s):  
Tetralogy Of Fallot ◽  
Wall Motion ◽  
Surgical Repair ◽  
Regional Wall Motion ◽  
Regional Wall

Abstract 17266: Right Atrial Volumes Changes in Tetralogy of Fallot

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_1) ◽  
Author(s):  
Ashish Patel ◽  
Divya Shakti ◽  
Chad Blackshear
Keyword(s):  
Diastolic Dysfunction ◽  
Diastolic Function ◽  
Tetralogy Of Fallot ◽  
Surgical Repair ◽  
Left Ventricular ◽  
Right Atrial ◽  
Before And After ◽  
Ventricular Diastolic Dysfunction ◽  
And Function ◽  
Averaged Model

Introduction & Hypothesis: There is limited information on right atrial (RA) function in the congenital heart defects. RA volume and function may give insight into the right ventricle (RV) diastolic function. We sought to assess RA function in tetralogy of Fallot (TOF) patients prior to and after complete surgical repair. Methods: Infants with TOF prior to complete repair were included for retrospective chart review and offline analysis of 2-dimensional echocardiograms (echo) before and after surgical repair. RA phasic volumes and stroke volumes were calculated. All volumes were indexed to body surface area. Results: There were 40 infants with TOF (45% females), of which 70% had pulmonary stenosis, 30% pulmonary atresia. Roughly 85% and 60% had 3, or more, echo available pre- and postoperatively. Table 1 (attached) shows the patient characteristics and phasic RA volumes. The indexed RA phasic volumes were in normal range in initial echo prior to surgery. We used normal index RA phasic volumes published by European Society of Echocardiography. There was the increasing trend of indexed RA phasic volume on follow up echo immediately before TOF repair. These phasic volumes continued to remain elevated after complete surgical repair (Table 1). Trends in RA stroke volumes for all available echos before and after surgery were modeled using a population-averaged model with an exchangeable within-panel correlation structure (Figure 2), showing no statistically significant difference after surgery. But there was statistical significance noted in RA ejection fraction. Please see attached image for statistical analysis and results of the study. Conclusions: The indexed RA phasic volumes in children with TOF are normal initially and increases before TOF repair and it continued to increase after TOF repair. The increase RA phasic volumes suggest RV diastolic dysfunction similar to the findings of LA phasic volumes and left ventricular diastolic dysfunction. Our findings indicate slow worsening RV diastolic function in patients with TOF after surgical repair. RA volume and function can be the novel marker to diagnose and monitor right ventricular diastolic dysfunction.

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