Does interatrial communication affect post-operative course of children undergoing tetralogy of Fallot repair? Single centre retrospective cohort study: propensity score matching

Introduction: During tetralogy of Fallot repair, leaving or even create an interatrial communication may facilitate post-operative course particularly with right ventricle restrictive physiology. The aim of our study is to assess the influence of atrial communication on post-operative course of tetralogy of Fallot repair. Methods: Retrospectively, we studied all children who had tetralogy of Fallot repair (2003–2018). We divided them into two groups: tetralogy of Fallot repair with interatrial communication (TOFASD) group and tetralogy of Fallot repair with intact atrial septum (TOFIAS) group. We performed propensity match score for specific pre- or intra-operative variables and compared groups for post-operative outcome variables. Secondarily, we looked for right ventricle restrictive physiology incidence and influence of early repair performed before 3 months of age on post-operative course. Results: One hundred and sixty children underwent tetralogy of Fallot repair including (93) cases of TOFIAS (58%) and (67) cases of TOFASD (42%). With propensity matching score, 52 patients from each group were compared. Post-operative course was indifferent in term of positive pressure ventilation time, vasoactive inotropic score, creatinine and lactic acid levels, duration and amount of chest drainage and length of intensive care unit and hospital stay. Right ventricle restrictive physiology occurred in 38% of patients with no effects on outcome. 12/104 patients (12%) with early repair needed longer pressure ventilation time (p = 0.003) and intensive care unit stay (p = 0.02). Conclusion: Leaving interatrial communication in tetralogy of Fallot repair did not affect post-operative course. As well, right ventricle restrictive physiology did not affect post-operative course. Infants undergoing early tetralogy of Fallot repair may require longer duration of positive pressure ventilation time and intensive care unit stay.

Applicability and Durability of Valve-Sparing Tetralogy of Fallot Repair

Background: Although valve-sparing repair remains ideal for patients with tetralogy of Fallot, the durability of valve-sparing repair and which patients may have been better served with a transannular patch remain unclear. Methods: Retrospective review was performed of tetralogy of Fallot operations at our institution from January 2008 to December 2018. Standard demographic data were collected, including echocardiographic parameters, operative details, and clinical outcomes. Statistical analysis was performed comparing the transannular patch and valve-sparing repair groups. Results: Sixty-seven patients underwent tetralogy of Fallot repair with a median age of 4.5 (3.2-6.0) months and weight of 5.8 (5.2, 6.7) kg. Seventeen (25%) patients underwent transannular patch repair and 50 (75%) patients underwent valve-sparing repair. There was no difference in age or weight between patients who underwent a transannular patch repair and those who underwent a valve-sparing repair. At last follow-up (median 42 months), there was a trend of a higher peak pulmonary valve/right ventricular outflow tract gradient ( P = .06) in the valve-sparing group, but no difference in the pulmonary valve annulus z-scores. Additionally, the pulmonary valve z-scores in the valve-sparing group decreased from −2.3 ± 1.0 on predischarge echocardiogram of to −1.2 ± 1.6 on last follow-up, with the peak gradient on predischarge 23 (0-37) mm Hg remaining stable on last follow-up at 18 (0-29) mm Hg. There was one reoperation: pulmonary valve replacement six years after a transannular patch. Conclusions: Obtaining a postrepair pulmonary valve z-score of −2 yields satisfactory, stable valve-sparing repair with pulmonary valve growth, acceptable gradients, minimal regurgitation, and high freedom from reintervention during follow-up.

Risk factors and long-term outcomes after tetralogy of Fallot repair at an Asian tertiary referral center

Background Tetralogy of Fallot is the most common type of cyanotic congenital heart disease. More postoperative tetralogy of Fallot patients grow up than in the past, and these patients need to be followed-up. Objective To investigate the survival and long-term outcomes of patients who underwent total repair of tetralogy of Fallot, and to identify the risk factors for reoperation with pulmonic valve replacement. Method A total of 403 patients who underwent total tetralogy of Fallot repair at our center during 1997 to 2016 were retrospectively included. Demographic, clinical, treatment, outcome, and follow-up data were collected and analyzed. Results Median age and body weight at the time of tetralogy of Fallot repair was 4.41 years (range: 0.85–55.28) and 13.58 kg (range: 5.5–68), respectively. The median follow-up was 9.0 years, and overall mortality was 3.2%. The actuarial survival rates at 10 and 20 years were 96.4% and 95.2%, respectively, and the freedom from pulmonic valve replacement was 93.4% and 57.4%, respectively. The median time to indicate pulmonic valve replacement was 13.9 years (range: 6.2–20.5). Multivariate analysis revealed transannular patch technique (hazard ratio: 3.023, 95% confidence interval: 1.34–6.83; p = 0.008) and palliative shunt (hazard ratio: 2.39, 95% confidence interval: 1.16–4.91; p = 0.018) to be independent risk factors for reoperation with pulmonic valve replacement. Conclusion The rates of overall survival and freedom from pulmonic valve replacement were both high in this study, and both were comparable to the rates reported from other studies. Overall mortality was as low as 3.47%. The need for a transannular patch or palliative shunt should be considered risk factors for a consequent reoperation.

The role of the neutrophil–lymphocyte ratio for pre-operative risk stratification of acute kidney injury after tetralogy of Fallot repair

Introduction: Acute kidney injury is a risk factor for chronic kidney disease and mortality after congenital heart surgery under cardiopulmonary bypass. The neutrophil–lymphocyte ratio is an inexpensive and easy to measure biomarker for predicting outcomes in children with congenital heart disease undergoing surgical correction. Objective: To identify children at high risk of acute kidney injury after tetralogy of Fallot repair using the neutrophil–lymphocyte ratio. Methods: This single-centre retrospective analysis included consecutive patients aged < 18 years who underwent tetralogy of Fallot repair between January 2014 and December 2018. The pre-operative neutrophil–lymphocyte ratio was measured using the last pre-operative complete blood count test. We used the Acute Kidney Injury Network definition. Results: A total of 116 patients were included, of whom 39 (33.6%) presented with acute kidney injury: 20 (51.3%) had grade I acute kidney injury, nine had grade II acute kidney injury (23.1%), and 10 (25.6%) had grade III acute kidney injury. A high pre-operative neutrophil–lymphocyte ratio was associated with grade III acute kidney injury in the post-operative period (p = 0.04). Patients with acute kidney injury had longer mechanical ventilation time (p = 0.023), intensive care unit stay (p < 0.001), and hospital length of stay (p = 0.002). Conclusion: Our results suggest that the pre-operative neutrophil–lymphocyte ratio can be used to identify patients at risk of developing grade III acute kidney injury after tetralogy of Fallot repair.

Supraventricular arrhythmia in tetralogy of Fallot repair

Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): Gottsegen National Cardiovascular Center BACKGROUND With aging morbidity related to arrhythmias in adult patients with Tetralogy of Fallot repair (TOFr) is increasing. OBJECTIVE We aimed to analyze the prevalence of supraventricular tachycardia in these patients using our prospective database. METHODS TOFr data were collected from our prospective database conducted since 2010. Supraventricular arrhythmias (intraatrial reentrant tachycardia (IART), atrial fibrillation, AFib) related complications and therapies were documented. RESULTS Among those with TOFr (n = 296, mean age 34 ± 11) supraventricular tachyarrhythmias (SVT) were present in 41 patients (14%), as following: n = 12 AFib, and n = 29 IART. At the univariate analysis predictors of atrial fibrillation and IART were: age at last follow-up (p &lt; 0,0001), age at first repair (p &lt; 0,0001), number of surgeries (p = 0,014), and tricuspid regurgitation (p = 0,013). Supraventricular tachycardia was a strong predictor of death (OR 3.0). Twenty-five patients had radiofrequency ablation, and after a mean follow-up of 61 ± 56 months, the rate of recurrence for SVT was 32 %. In the non-ablated cohort (treated with amiodarone) 73 % recurrence was detected. CONCLUSION Supraventricular arrhythmias are common in TOFr patients and are associated with increased mortality risk, but arrhythmia control with catheter ablation is superior to anti-arrhythmic drug therapy in this patient population.