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Primary repair versus surgical and transcatheter palliation in infants with tetralogy of Fallot

Research output: Contribution to journalArticle

Original languageEnglish
Pages (from-to)1864-1870
Number of pages7
JournalHeart
Volume104
Issue number22
Early online date2 May 2018
DOIs
DateAccepted/In press - 10 Apr 2018
DateE-pub ahead of print - 2 May 2018
DatePublished (current) - Nov 2018

Abstract

OBJECTIVES: Treatment of infants with tetralogy of Fallot (ToF) has evolved in the last two decades with increasing use of primary surgical repair (PrR) and transcatheter right ventricular outflow tract palliation (RVOTd), and fewer systemic-to-pulmonary shunts (SPS). We aim to report contemporary results using these treatment options in a comparative study.

METHODS: This a retrospective study using data from the UK National Congenital Heart Disease Audit. All infants (n=1662, median age 181 days) with ToF and no other complex defects undergoing repair or palliation between 2000 and 2013 were considered. Matching algorithms were used to minimise confounding due to lower age and weight in those palliated.

RESULTS: Patients underwent PrR (n=1244), SPS (n=311) or RVOTd (n=107). Mortality at 12 years was higher when repair or palliation was performed before the age of 60 days rather than after, most significantly for primary repair (18.7% vs 2.2%, P<0.001), less so for RVOTd (10.8% vs 0%, P=0.06) or SPS (12.4% vs 8.3%, P=0.2). In the matched groups of patients, RVOTd was associated with more right ventricular outflow tract (RVOT) reinterventions (HR=2.3, P=0.05 vs PrR, HR=7.2, P=0.001 vs SPS) and fewer pulmonary valve replacements (PVR) (HR=0.3 vs PrR, P=0.05) at 12 years, with lower mortality after complete repair (HR=0.2 versus PrR, P=0.09).

CONCLUSIONS: We found that RVOTd was associated with more RVOT reinterventions, fewer PVR and fewer deaths when compared with PrR in comparable, young infants, especially so in those under 60 days at the time of the first procedure.

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  • Centre for Surgical Research

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  • Journal Article

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    Rights statement: This is the author accepted manuscript (AAM). The final published version (version of record) is available online via BMJ at https://heart.bmj.com/content/104/22/1864. Please refer to any applicable terms of use of the publisher.

    Accepted author manuscript, 167 KB, PDF document

    Licence: CC BY-NC

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