CoChat
Sign Up
Cited by 1Congenital Heart Disease StudiesCardiovascular Conditions and TreatmentsGlobal Health and Surgery

Early surgical outcome for Tetralogy Of Fallot In An African Setting; A Tanzanian experience using retrospective analysis of hospital data

Open access
Majani, Naizihijwa, Sharau, Godwin, Mlawi, Vivienne, Kalezi, Zawadi, Mongella, Stella, Letara, Nuru, Nkya, Deogratias, Kubhoja, Sulende +5 more·2024·BMC Cardiovascular Disorders
DOI 10.1186/s12872-024-04183-5PMC PMC11401386

Published version of a preprint

Open this paper in CoChat — free accountOpen PDF

Abstract

BACKGROUND: Tetralogy of Fallot (TOF) is typically treated in infancy but often done late in many resource-limited countries, jeopardizing surgical outcomes. This study examined the early results of children undergoing primary complete TOF repair at the Jakaya Kikwete Cardiac Institute (JKCI) in Tanzania, an emerging cardiac center in Eastern Africa. METHODS: A retrospective cohort study of children ≤ 18 years undergoing primary TOF complete repair between 2019 and 2021 was conducted. Patients with complex TOF and those with obvious genetic syndrome were excluded. Data on socio-demography, pre-and postoperative cardiac complications, Intensive Care Unit (ICU) and hospital stay, and in-hospital and 30-day mortality were analyzed. Logistic regressions were employed to find the factors for mortality, ICU, and hospital stays. RESULTS: Haematocrits were high, with a median of 48.7 (IQR: 37.4-59.0). The median oxygen saturation was 81% (IQR:72-93). Over a third of patients (38.2%; n = 39) needed Trans annular patch (TAP) during surgery. The median ICU stay was 72 h (IQR:48-120), with ICU duration exceeding three days for most patients. The median hospital stay was 8.5 days (IQR:7-11), with 70 patients (68.2%)experiencing an extended hospital stay of > 7 days. Bacterial sepsis was more common than surgical site infection (5.6%; n = 6 vs. 0.9%;n = 1). No patient needed re-operation for the period of follow up. The in-hospital mortality rate was 5.9%, with no deaths occurring in children less than one year of age nor after discharge during the 30-day follow-up period. No statistically significant differences were observed in outcomes in relation to age, sex, levels of hematocrit and saturations, presence of medical illnesses, and placement of TAP. CONCLUSION: TOF repairs in this African setting at a national cardiac referral hospital face challenges associated with patients' older age and compromised nutritional status during the surgery. Perioperative mortality rates and morbidity for patients operated at an older age remain elevated. It's important to address these issues to improve outcomes in these settings.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1186/s12872-024-04183-5

Cites

6 of 6 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Single-center studies from Pakistan and Tanzania reported mortality rates of 1.3-9% for late repairs, with higher rates generally associated with poorer preoperative condition and lower institutional capacity.

    “Single-center studies from Pakistan and Tanzania reported mortality rates of 1.3–9% for late repairs, with higher rates generally associated with poorer preoperative condition and lower institutional capacity [15–16].”

    From Management of tetralogy of fallot in developing countries: opportunities and challenges for surgeons (2026) · cites this paper as [15]

    The Discussion reports 5.9% 30-day mortality in the Tanzanian cohort and cites 1.3% in a Pakistani cohort; it also discusses patient condition and healthcare-center expertise as possible contributors to higher mortality. But its 9% figure comes from a separate 22-patient visiting-team study, not the Tanzanian or Pakistani cohorts, and its Results say the observed patient-level mortality associations were not statistically significant. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • The mortality rate is comparable to the upper range reported from centers in the early stages of congenital cardiac program development.

    “While the 11% mortality observed in our study exceeds that of many published LMIC series, it remains comparable to the upper range reported from centers in the early stages of congenital cardiac program development [15].”

    From Management of tetralogy of fallot in developing countries: opportunities and challenges for surgeons (2026) · cites this paper as [15]

    The Discussion (page unavailable) reports operative mortality of 6.9–15% in developing countries and gives a 12.9% example, so an 11% rate falls within the reported range. It does not identify those centers as being in the early stages of congenital cardiac program development; its own observed mortality was 5.9%. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

  • The mortality rate is higher than rates reported in high-volume centers with early interventions.

    “Despite the low morbidity, mortality was recorded in five patients (11.6%), which is higher than rates reported in high-volume centers with early interventions [15–16].”

    From Management of tetralogy of fallot in developing countries: opportunities and challenges for surgeons (2026) · cites this paper as [15]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

Research works printed but not linked: 29

  1. [2]Van der Ven JPG, van den Bosch E, Bogers AJCC, Helbing WA. Current outcomes and treatment of tetralogy of Fallot. F1000Res. 2019;8: F1000 Faculty Rev-1530. Published 2019 Aug 29. PMC6719677 31508203
  2. [3]Mouws EMJP, de Groot NMS, van de Woestijne PC, de Jong PL, Helbing WA, van Beynum IM, Bogers AJJC. Tetralogy of Fallot in the current era. Semin Thorac Cardiovasc Surg. 2019;31(3):496–504. 10.1053/j.semtcvs.2018.10.015. 30395964 10.1053/j.semtcvs.2018.10.015 · DOI
  3. [4]Loomba RS, Buelow MW, Woods RK. Complete repair of tetralogy of Fallot in the neonatal Versus Nonneonatal Period: a Meta-analysis. Pediatr Cardiol. 2017;38(5):893–901. 28190140 10.1007/s00246-017-1579-8 · DOI
  4. [5]Valente AM, Gauvreau K, Assenza GE, et al. Contemporary predictors of death and sustained ventricular tachycardia in patients with repaired tetralogy of Fallot enrolled in the INDICATOR cohort. Heart. 2014;100(3):247–53. 24179163 10.1136/heartjnl-2013-304958 PMC3913216 · DOI
  5. [6]van der Ven JPG, van den Bosch E, Bogers AJCC, Helbing WA. (2019). Current outcomes and treatment of tetralogy of fallot [version 1; peer review: 2 approved]. F1000Research, 8, 1–15. 10.12688/f1000research.17174.1 PMC6719677 31508203 · DOI · Paper page
  6. [7]Sandoval N, Carreño M, Novick WM, Agarwal R, Ahmed I, Balachandran R, Balestrini M, Cherian KM, Croti U, Du X, Gauvreau K, Cam Giang DT, Shastri R, Jenkins KJ. Tetralogy of Fallot Repair in developing countries: International Quality Improvement Collaborative. Ann Thorac Surg. 2018;106(5):1446–51. 10.1016/j.athoracsur.2018.05.080. 29969617 10.1016/j.athoracsur.2018.05.080 · DOI · Paper page
  7. [8]Ngwezi DP, Vanderdonck K, Levin SE, Cilliers A. An audit of surgical repair of tetralogy of Fallot in an African tertiary care center. SA Heart. 2013;10(3):520–5.
  8. [9]Juliana J, Sembiring YE, Rahman MA, Soebroto H. Mortality risk factors in tetralogy of Fallot patients undergoing total correction. Folia Med Indonesiana. 2021;57(2):151. 10.20473/fmi.v57i2.22107. 10.20473/fmi.v57i2.22107 · DOI
  9. [10]Saygi M, Ergul Y, Tola HT, et al. Factors affecting perioperative mortality in tetralogy of Fallot. Pediatr Int. 2015;57(5):832–9. 25807889 10.1111/ped.12627 · DOI
  10. [12]Bertranou EG, Blackstone EH, Hazelrig JB, Turner ME, Kirklin JW. (1978). Life expectancy without surgery in tetralogy of Fallot. Am. J. Cardiol. 42 (3): 458–66. 10.1016/0002-9149(78)90941-4. PMID 685856. Hashemzadeh K, Hashemzadeh S (2010). Early and late results of total correction of tetralogy of Fallot. Acta Med Iranica 48, 117- 122. 685856 · DOI
  11. [13]Van Dongen EI, Glansdorp AG, Mildner RJ, McCrindle BW, Sakopoulos AG, VanArsdell G, Williams WG, Bohn D. The influence of perioperative factors on outcomes in children aged less than 18 months after repair of tetralogy of Fallot. J Thorac Cardiovasc Surg. 2003;126(3):703–10. 10.1016/S0022-5223(03)00035-7. 14502142 10.1016/S0022-5223(03)00035-7 · DOI
  12. [15]Azari A, Nezafati MH, Bigdelu L. Early post operative mortality of total correction of tetralogy of Fallot. J Cardio-Thoracic Med. 2017;5(4):222–5.
  13. [16]Pinheiro P, de Azevedo S, V. M. P., Rocha G. Predicting factors of Surgical Mortality in Children and adolescents undergoing correction of tetralogy of Fallot. Int J Cardiovasc Sci. 2023;36:1–11. 10.36660/ijcs.20200394. 10.36660/ijcs.20200394 · DOI
  14. [17]Saygi M, Ergul Y, Tola HT, Ozyilmaz I, Ozturk E, Onan IS, Haydin S, Erek E, Yeniterzi M, Guzeltas A, Odemis E, Bakir I. Factors affecting perioperative mortality in tetralogy of Fallot. Pediatr Int. 2015;57(5):832–9. 10.1111/ped.12627. 25807889 10.1111/ped.12627 · DOI
  15. [18]Hashemzadeh K, Hashemzadeh S. Early and late results of total correction of tetralogy of fallot. Acta Medica Iranica. 2010;48(2):117–22. 21133005
  16. [19]Tefera E, Gedlu E, Nega B, Tadesse BT, Chanie Y, Dawoud A, Moges FH, Bezabih A, Moges T, Centella T, Marianeschi S, Coca A, Collado R, Kassa MW, Johansson S, van Doorn C, Barber BJ, Teodori M. Factors associated with perioperative mortality in children and adolescents operated for tetralogy of Fallot: a sub-saharan experience. J Card Surg. 2019;34(12):1478–85. 10.1111/jocs.14270. 31600427 10.1111/jocs.14270 · DOI
  17. [21]Nadir Benbrik Bénédicte, Romefort LL, Golan et al. March.: Late repair of tetralogy of Fallot during childhood in patients from developing countries, European Journal of Cardio-Thoracic Surgery, Volume 47, Issue 3, 2015, Pages e113–e117. 25473030
  18. [23]Dixon LK, Dimagli A, Di Tommaso E, Sinha S, Fudulu DP, Sandhu M, Benedetto U, Angelini GD. Females have an increased risk of short-term mortality after cardiac surgery compared to males: insights from a national database. J Card Surg. 2022;37(11):3507–19. 10.1111/jocs.16928. 36116056 10.1111/jocs.16928 PMC9826035 · DOI
  19. [24]S, T. S. T. K, M, L, S, R, R. R-K, C. Sex-related disparity in surgical mortality among pediatric patients. Congenit Heart Dis. 2006;1(3):77–88. http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=emed7&NEWS=N&AN=2006257860. 18377550
  20. [25]Marelli A, Gauvreau K, Landzberg M, Jenkins K. Sex differences in mortality in children undergoing congenital heart disease surgery: a United States population-based study. Circulation. 2010;122(11 SUPPL 1):234–40. 10.1161/CIRCULATIONAHA.109.928325. 10.1161/CIRCULATIONAHA.109.928325 20837919 · DOI
  21. [26]LEACHMAN RD, HALLMAN, G. L., COOLEY DA. Relationship between Polycythemia and Surgical Mortality in patients undergoing total correction for tetralogy of Fallot. Circulation. 1965;32(July):65–8. 10.1161/01.CIR.32.1.65. 14314494 10.1161/01.CIR.32.1.65 · DOI
  22. [27]Ergün S, Genç SB, Yildiz O, Öztürk E, Güneş M, Onan IS, Güzeltaş A, Haydin S. Predictors of a complicated course after surgical repair of tetralogy of Fallot. Turkish J Thorac Cardiovasc Surg. 2020;28(2):264–73. 10.5606/tgkdc.dergisi.2020.18829. 10.5606/tgkdc.dergisi.2020.18829 PMC7298368 32551156 · DOI
  23. [28]Faerber JA, Huang J, Zhang X, Song L, DeCost G, Mascio CE, Ravishankar C, O’Byrne ML, Naim MY, Kawut SM, Goldmuntz E, Mercer-Rosa L. Identifying risk factors for complicated postoperative course in tetralogy of Fallot using a machine learning Approach. Front Cardiovasc Med. 2021;8(July):1–10. 10.3389/fcvm.2021.685855. 10.3389/fcvm.2021.685855 PMC8339319 34368247 · DOI
  24. [29]Al Habib HF, Jacobs JF, Mavroudis C, Tchervenkov CI, O’Brien SM, Mohammadi S, et al. Contemporary patterns of management of tetralogy of Fallot: data from the Society of thoracic surgeons database. Ann Thorac Surg. 2010;90:813–20. 20732501 10.1016/j.athoracsur.2010.03.110 · DOI · Paper page
  25. [31]Naghib S, van der Starre C, Gischler SJ, Joosten KF, Tibboel D. Mortality in very long-stay pediatric intensive care unit patients and incidence of withdrawal of treatment. Intensive Care Med. 2010;36(01):131–6. 19855954 10.1007/s00134-009-1693-z · DOI
  26. [34]Harris 1PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap) – a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inf. 2009;42(2):377–81. 10.1016/j.jbi.2008.08.010 PMC2700030 18929686 · DOI · Paper page
  27. [35]Harris 2PA, Taylor R, Minor BL, Elliott V, Fernandez M, O’Neal L, McLeod L, Delacqua G, Delacqua F, Kirby J, Duda SN, REDCap Consortium. The REDCap consortium: building an international community of software partners. J Biomed Inf. 2019 May;9. 10.1016/j.jbi.2019.103208]. PMC7254481 31078660 · DOI · Paper page
  28. [36]Hickey PA, Connor JA, Cherian KM, et al. International quality improvement initiatives. Cardiol Young. 2017;27(S6):S61–8. 10.1017/S1047951117002633. 29198264 10.1017/S1047951117002633 · DOI
  29. [37]Liu Y, Chen S, Zühlke L, Babu-Narayan SV, Black GC, Choy MK, Li N, Keavney BD. Global prevalence of congenital heart disease in school-age children: a meta-analysis and systematic review. BMC Cardiovasc Disord. 2020;20:1–0. 33213369 10.1186/s12872-020-01781-x PMC7678306 · DOI

Cited by

Sorted by citations

Authors
Majani, N., Sharau, G., Mlawi, V., Kalezi, Z., Mongella, S., Letara, N., Nkya, D., Kubhoja, S., Chillo, P., Slieker, M., Janabi, M., Grobbee, D., & Kisenge, P.
Affiliations
  • Jakaya Kikwete Cardiac Institute (TZ)
  • Muhimbili University of Health and Allied Sciences (TZ)
  • Wilhelmina Children's Hospital (NL)
  • Muhimbili National Hospital (TZ)
Corresponding author
Majani, Naizihijwa
ORCID
Venue
BMC Cardiovascular Disorders
Publisher
Springer Science and Business Media LLC
Published
2024-09-14
Volume
24
Issue
1
Pages
493-493
ISSN
1471-2261 (ISSN-L)
DOI
10.1186/s12872-024-04183-5
PMC
PMC11401386
OpenAlex
W4402538395
Cited by
1
References
6
Citations by year
2026: 1
FWCI
0.31
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Cardiovascular Disorders (publishedVersion, cc-by-nc-nd)
  • Research Square (acceptedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
  • Utrecht University Repository (Utrecht University) (submittedVersion, other-oa)
Topics
  • Health Sciences › Medicine › Epidemiology › Congenital Heart Disease Studies
  • Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiovascular Conditions and Treatments
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Global Health and Surgery
Keywords
tetralogy of Fallot, pediatric cardiac surgery, surgical outcomes, in-hospital mortality, ICU length of stay, length of hospital stay, transannular patch, bacterial sepsis, surgical site infection, oxygen saturation, delayed surgical repair, resource-limited settings, Tanzania
MeSH terms
Adolescent, Child, Child, Preschool, Female, Cardiac Surgical Procedures, Humans, Infant, Length of Stay, Male, Postoperative Complications, Retrospective Studies, Risk Factors, Tanzania, Tetralogy of Fallot, Time Factors, Treatment Outcome, Hospital Mortality, Risk Assessment

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review