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Cited by 80Congenital Heart Disease StudiesCongenital heart defects researchCardiac Structural Anomalies and Repair

Results of reparative surgery for tetralogy of Fallot: data from the European Association for Cardio-Thoracic Surgery Congenital Database

Sarris, G. E., Comas, J. V., Tobota, Z., Maruszewski, B.·2012·European Journal of Cardio-Thoracic Surgery
DOI 10.1093/ejcts/ezs478
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Abstract

OBJECTIVES: Right ventricular (RV) dysfunction and pulmonary insufficiency (PI) after tetralogy of Fallot (TOF) repair may contribute to early and late morbidity and mortality. RV dysfunction may be related to the ventriculotomy employed in the transventricular repair technique, particularly when it is combined with a transannular patch (TAP). Transatrial/transpulmonary (TA/TP) repair without ventriculotomy has been advocated as a method potentially diminishing such adverse events. However, the prevalence and early as well as the late results of these different surgical approaches in Europe have not been studied. To ascertain 'the current prevalence and associated early mortality' of various surgical approaches for repair of TOF, relevant data in the European Association for Cardio-Thoracic Surgery Congenital Database were analysed. METHODS: The study population was all types of reparative operations (n = 6654) for patients with primary diagnosis of TOF reported between 1999 and 2011. RESULTS: Overall hospital mortality (HM) was 2.58% (172 of 6654). Repair via ventriculotomy with TAP was the most prevalent technique (n = 3827, 57.5%), with HM 3.11%. Repair via ventriculotomy with non-TAP was performed in 1309 patients (19.7%, HM = 1.53%). Repair without ventriculotomy was performed in 1214 patients (18.2%, HM = 1.48%). Logistic regression analysis showed statistically significant association between HM risk and the type of surgery. In particular, ventriculotomy with TAP is associated with increased mortality risk significantly compared with ventriculotomy with non-TAP (crude odds ratio [OR] 2.13 (95% confidence interval [CI]: 1.33-3.63). Similar results were obtained by analysing for operative mortality risk (30-day mortality, OM). Operations that have been performed before 2005 have resulted in increased surgical risk compared with those performed after 2005 (ORs for OM 1.45, 95% CI: 1.03-2.013). CONCLUSIONS: Overall HM for TOF repair is low. TOF repair by means of ventriculotomy with TAP is the most prevalent approach and is associated with higher mortality. Repair with ventriculotomy but no TAP and repair without ventriculotomy are both less prevalent and with lower mortality. Surgical risk appears to be decreasing over time.

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Authors
Sarris, G. E., Comas, J. V., Tobota, Z., & Maruszewski, B.
Affiliations
  • Hygeia Hospital (GR)
  • Hospital Universitario 12 De Octubre (ES)
  • Children's Memorial Health Institute (PL)
Corresponding author
Sarris, G. E.
ORCID
Venue
European Journal of Cardio-Thoracic Surgery
Publisher
Oxford University Press (OUP)
Published
2012-10-18
Volume
42
Issue
5
Pages
766-774
ISSN
  • 1010-7940 (ISSN-L)
  • 1873-734X
DOI
10.1093/ejcts/ezs478
OpenAlex
W2133972715
Cited by
80
References
32
Citations by year
2026: 6 · 2025: 2 · 2024: 7 · 2023: 6 · 2022: 7 · 2021: 7 · 2020: 2 · 2019: 10 · 2018: 4 · 2017: 5 · 2016: 9 · 2015: 5 · 2014: 3 · 2013: 6 · 2012: 1
FWCI
3.59
Type
journal article
Language
en
Open access
closed
Locations
  • European Journal of Cardio-Thoracic Surgery (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Epidemiology › Congenital Heart Disease Studies
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Congenital heart defects research
  • Health Sciences › Medicine › Surgery › Cardiac Structural Anomalies and Repair
Keywords
tetralogy of Fallot, right ventricular dysfunction, pulmonary insufficiency, ventriculotomy, transannular patch, postoperative mortality, 30-day mortality, in-hospital mortality, surgical technique comparison, congenital heart surgery outcomes
MeSH terms
Child, Child, Preschool, Europe, Heart Atria, Cardiac Surgical Procedures, Heart Ventricles, Humans, Infant, Retrospective Studies, Risk Factors, Tetralogy of Fallot, Multivariate Analysis, Logistic Models, Odds Ratio, Databases, Factual, Treatment Outcome, Hospital Mortality, Cardiac Valve Annuloplasty

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