Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Mar;109(3):802-808.
doi: 10.1016/j.athoracsur.2019.10.013. Epub 2019 Nov 26.

Staged Versus Complete Repair in the Symptomatic Neonate With Tetralogy of Fallot

Jennifer Bailey  1 , Okan U Elci  2 , Christopher E Mascio  3 , Laura Mercer-Rosa  4 , Elizabeth Goldmuntz  5
Affiliations

Staged Versus Complete Repair in the Symptomatic Neonate With Tetralogy of Fallot

Jennifer Bailey et al. Ann Thorac Surg. 2020 Mar.

Abstract

Background: The optimal management of tetralogy of Fallot (TOF) in symptomatic neonates remains unknown. We compared outcomes for those undergoing palliation vs complete repair in the neonatal period.

Methods: In a retrospective cohort study of symptomatic neonates with TOF who had a neonatal complete repair (group 1, n = 112) or staged repair (group 2, n = 26) from 2000 to 2013, we compared outcomes at 4 time points: neonatal complete repair vs palliation (group 1 vs 2A), neonatal vs later complete repair (group 1 vs 2B), the single vs combined admissions to achieve a complete repair (group 1 vs group 2A + 2B), and cumulative events 2 years after complete repair for both groups.

Results: Demographics, anatomy, comorbidities, surgical approach, and mortality were similar between groups 1 and 2. Group 1 had a longer duration of cardiopulmonary bypass and deep hypothermic circulatory arrest and more postprocedure cardiac events compared with group 2A; a longer duration of intubation, intensive care, and postprocedure hospital stay compared with groups 2A and 2B; and a longer total hospital stay compared with group 2B. With combined admissions for group 2, there was no difference in the total duration of intensive care, total hospital stay, or reinterventions compared with group 1.

Conclusions: Both management options result in similar survival; however, early morbidity was greater with neonatal complete repair. The impact of increased neonatal exposures, such as cardiopulmonary bypass, deep hypothermic circulatory arrest, and intensive care, on neurocognitive development requires further study but should be considered when choosing an optimal strategy.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Legend. Surgical Cohort. ** Subjects with pulmonary atresia with multiple aortopulmonary collateral arteries who had neonatal shunts and VSD left open at 2nd operation
See this image and copyright information in PMC

Comment in

  • Invited Commentary.
    Hsia TY. Hsia TY. Ann Thorac Surg. 2020 Mar;109(3):808-809. doi: 10.1016/j.athoracsur.2019.10.077. Epub 2019 Dec 19. Ann Thorac Surg. 2020. PMID: 31866483 No abstract available.

References

    1. Lee CH, Kwak JG, Lee C. Primary repair of symptomatic neonates with tetralogy of Fallot with or without pulmonary atresia. Korean J Pediatr. 2014;57(1):19–25. doi: 10.3345/kjp.2014.57.1.19. - DOI - PMC - PubMed
    1. Al Habib HF, Jacobs JP, Mavroudis C, et al. Contemporary patterns of management of tetralogy of Fallot: data from the Society of Thoracic Surgeons Database. Ann Thorac Surg. 2010;90(3):813–819; discussion 819–820. Epub 2010/08/25. doi: 10.1016/j.athoracsur.2010.03.110. - DOI - PubMed
    1. Wilder TJ, VanArsdell GS, Benson L, et al. Young infants with severe Tetralogy of Fallot: Early primary surgery versus transcatheter palliation. J Thorac Cardiovasc Surg. 2017; :1–9) - PubMed
    1. Tamesberger MI, Lechner E, Mair R, Hofer A, Sames-Dolzer E, Tulzer G. Early primary repair of tetralogy of fallot in neonates and infants less than four months of age. Ann Thorac Surg. 2008;86(6):1928–1935. doi: 10.1016/j.athoracsur.2008.07.019. - DOI - PubMed
    1. Van Arsdell GS, Maharaj GS, Tom J, et al. What is the optimal age for repair of tetralogy of Fallot? Circulation. 2000;102(19 Suppl 3):III123–129. - PubMed

Publication types