Contemporary patterns of care in tetralogy of Fallot: analysis of the Society of Thoracic Surgeons data
Open accessAbstract
Background Against the background of earlier studies, recent patterns in surgical management of tetralogy of Fallot (TOF) were assessed.Methods A retrospective review of The Society of Thoracic Surgeons (STS) Congenital Database (2010-2020) was performed on patients aged <18 years with TOF or pulmonary stenosis and primary procedure TOF surgical repair or palliation. Procedural frequencies were examined by epoch. Demographics, clinical variables, and outcomes were compared between the initial palliation and primary repair groups. Among those operated on at 0 to 60 days of age, variation in palliation rates across hospitals was assessed.Results The 12,157 operations included 11,307 repairs (93.0%) and 850 palliations (7.0%); 68.5% of all palliations were modified Blalock-Taussig-Thomas shunts. Of 1105 operations on neonates, 45.4% (502) were palliations. Among neonates, palliations declined from 49.0% (331 of 675) in epoch 1 (2010-2015) to 39.8% (171 of 430) in epoch 2 (2016-2020; P = .0026). Overall, the most prevalent repair technique (5196 of 11,307; 46.0%) was ventriculotomy with transanular patch, which was also used in 520 of 894 (58.2%) of repairs after previous cardiac operations. Patients undergoing initial palliation demonstrated more preoperative STS risk factors (50.1% vs 24.3% respectively; P < .0001) and more major morbidity and mortality than patients undergoing primary repair (21.2% vs 7.46%; P < .0001). In the 0- to 60-day age group, risk factor-adjusted palliation rates across centers varied considerably, with 32 of 99 centers performing significantly more or significantly fewer palliations than predicted on the basis of their case mix.Conclusions Surgical palliation rates have decreased across all age groups despite increasing prevalence of risk factors. Ventriculotomy with transanular patch remains the most prevalent repair type. The considerable center-level variation in rates of palliation was not completely explained by case mix.
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In the STS study, more than 85% of Blalock-Taussig-Thomas shunts were performed before 3 months of age.
“In contrast, more than 85% of the BTT shunts were performed before 3 months of age in the STS study.”
From Tetralogy of Fallot in Low- and Middle-Income Countries (2024) · cites this paper as [33]
The Results report that 582 of 850 palliations were modified Blalock-Taussig-Thomas shunts, and that 59% of all palliations occurred in neonates aged 0–30 days. Table 2 gives the age distribution for palliation overall, not for BTT shunts specifically. The copy therefore does not establish that more than 85% of BTT shunts occurred before 3 months of age. (LLM, conf=0.78)
Experimental — accuracy not yet measuredA recent STS analysis found a 3.4% (27 of 796) mortality in patients who underwent palliation, approximately 70% of whom received a Blalock-Taussig-Thomas shunt.
“In contrast, a recent STS analysis found a 3.4% (27 of 796) mortality in patients who underwent palliation (approximately 70% of these patients received a BTT shunt).33”
From Tetralogy of Fallot in Low- and Middle-Income Countries (2024) · cites this paper as [33]
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Al Habib, H. F., Jacobs, J. P., Mavroudis, C., Tchervenkov, C. I., O'Brien, S. M., Mohammadi, S., & Jacobs, M. L. (2010) · The Annals of Thoracic Surgery · doi:10.1016/j.athoracsur.2010.03.110 · Cited by 307 · see citing works
Self-citationJacobs, J. P., Mavroudis, C. D., Jacobs, M. L., Maruszewski, B. J., Tchervenkov, C. I., Lacour-Gayet, F. G., Clarke, D. R., Yeh, T. J., Walters, H. L., Kurosawa, H., et al. (2006) · The Annals of Thoracic Surgery · doi:10.1016/j.athoracsur.2005.11.063 · Cited by 266 · see citing works
Self-citationO’Brien, S. M., Jacobs, J. P., Pasquali, S. K., Gaynor, J. W., Karamlou, T., Welke, K. F., Filardo, G., Han, J. M., Kim, S., Shahian, D. M., et al. (2015) · The Annals of Thoracic Surgery · doi:10.1016/j.athoracsur.2015.07.014 · Cited by 185 · see citing works
Self-citationReport From the Society of Thoracic Surgeons National Database Workforce
Overman, D. M., Jacobs, J. P., Prager, R. L., Wright, C. D., Clarke, D. R., Pasquali, S. K., O’Brien, S. M., Dokholyan, R. S., Meehan, P., McDonald, D., et al. (2013) · World Journal for Pediatric and Congenital Heart Surgery · doi:10.1177/2150135112461924 · Cited by 140 · see citing works
Self-citationControlled Cross Circulation for Direct-Vision Intracardiac Surgery
Lillehei, C. W. (1955) · Postgraduate Medicine · doi:10.1080/00325481.1955.11708211 · Cited by 92 · see citing works
Sarris, G. E., Comas, J. V., Tobota, Z., & Maruszewski, B. (2012) · European Journal of Cardio-Thoracic Surgery · doi:10.1093/ejcts/ezs478 · Cited by 80 · see citing works
Qureshi, A. M., Caldarone, C. A., Romano, J. C., et al. (2021) · Journal of Thoracic and Cardiovascular Surgery · doi:10.1016/j.jtcvs.2021.01.100 · Cited by 32 · see citing works
Development of a Congenital Heart Surgery Composite Quality Metric: Part 2—Analytic Methods
O’Brien, S. M., Jacobs, J. P., Shahian, D. M., et al. (2018) · The Annals of Thoracic Surgery · doi:10.1016/j.athoracsur.2018.07.036 · Cited by 29 · see citing works
Self-citationJacobs, J. P. (2014) · Current Opinion in Cardiology · doi:10.1097/hco.0000000000000133 · Cited by 14 · see citing works
Self-citationLong-term outcomes of staged repair of tetralogy of Fallot
Ye, X. T., Buratto, E., Schulz, A., Macalister, S. J., Weintraub, R. G., Brizard, C. P., & Konstantinov, I. E. (2022) · Journal of Thoracic and Cardiovascular Surgery · doi:10.1016/j.jtcvs.2022.07.026 · Cited by 7 · see citing works
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Research works printed but not linked: 1
- [1]1. Blalock A, Taussig HB. The surgical treatment of malformations of the heart in which there is pulmonary stenosis or pulmonary atresia. J Am Med Assoc. 1945;128:189-202.
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Tetralogy of Fallot in Low- and Middle-Income Countries
Dib, N., Chauvette, V., Diop, M. S., Bouhout, I., Hadid, M., Vô, C., Khairy, P., & Poirier, N. (2024) · CJC Pediatric and Congenital Heart Disease · doi:10.1016/j.cjcpc.2023.12.002 · Cited by 12 · see citing works
“33 However, there are important caveats when comparing these outcomes.”
Background
- Authors
- Clarke, N. S., Thibault, D., Alejo, D., Chiswell, K., Hill, K. D., Jacobs, J. P., Jacobs, M. L., Mettler, B. A., & Gottlieb Sen, D.
- Affiliations
- Cincinnati Children's Hospital Medical Center (US)
- Duke University (US)
- Johns Hopkins University (US)
- University of Florida Health (US)
- ORCID
- Venue
- The Annals of Thoracic Surgery
- Publisher
- Elsevier BV
- Published
- 2023-10
- Volume
- 116
- Issue
- 4
- Pages
- 768-775
- ISSN
- 0003-4975 (ISSN-L)
- OpenAlex
- W4381620894
- Cited by
- 16
- References
- 11
- Citations by year
- 2026: 2 · 2025: 6 · 2024: 5 · 2023: 3
- FWCI
- 3.18
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The Annals of Thoracic Surgery (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Society of Thoracic Surgeons
- Topics
- Health Sciences › Medicine › Epidemiology › Congenital Heart Disease Studies
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiovascular Conditions and Treatments
- Health Sciences › Medicine › Surgery › Cardiac and Coronary Surgery Techniques
- Keywords
- tetralogy of Fallot, palliative surgery, primary repair, neonatal cardiac surgery, surgical outcomes, pulmonary stenosis, repeat cardiac surgery
- MeSH terms
- Cardiac Surgical Procedures, Humans, Infant, Infant, Newborn, Palliative Care, Pulmonary Artery, Retrospective Studies, Tetralogy of Fallot, Treatment Outcome, Surgeons
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