Outcomes of Tetralogy of Fallot repair performed after three years of age
Abstract: The timing for
Tetralogy of Fallot (ToF) repair is a subject of debate, however, in general
repair before 3 years of age has resulted in good myocardial performance. Late
repair has led to prolonged QRS duration, ventricular dysfunction in terms of
myocardial performance index (MPI) and tricuspid annular plane systolic
excursion (TAPSE), as well as longer intensive care unit (ICU) stays.
Objective To evaluate QRS duration, right ventricular function as
measured by TAPSE, and ICU length of stay (LoS) after repair of TOF performed
after three years of age.
Methods This retrospective cohort study was performed in children and
adults who underwent ToF repair, with a minimum follow-up of 6 months. The
TAPSE and QRS duration were evaluated during follow-up and compared between
children who had the operation before vs. 3 years of age or older using Mann
Whitney U and Chi-square tests.
Results We enrolled 52 subjects who underwent ToF repair from January
2007 to June 2013 (18 in the ≤3 years-old group and 34 in the >3 years-old
group). Subjects’ age at the time of repair ranged from 7 months to 25 years,
with follow-up data at 24-30 months after discharge. Abnormalities of the right
ventricle and left ventricle MPI were not significantly different between the
two groups. However, we observed significant differences between the ≤3 years
and >3 years groups in median ICU LoS [2 (range 1-9) days vs. 1.5 (range
1-46) days, respectively; (P=0.016)] and median QRS durations [118 (range
78-140) ms vs. 136 (range 80-190) ms, respectively; (P=0.039)]. The age at the
time of repair did not increase the risk of having abnormal TAPSE (RR 0.85;
95%CI 0.26 to 2.79; P=0.798).
Conclusion Tetralogy of Fallot repair after 3 years of age appears to not
increase ICU LoS or is associated with lower TAPSE, but it is associated with longer
QR duration.
Author: Ni Putu Veny Kartika
Yantie, Mulyadi M. Djer, Najib Advan, Jusuf Rachmat
Journal Code: jpkedokterangg160061