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. 2024 Jun 26;24(1):322.
doi: 10.1186/s12872-024-03991-z.

Primary surgical repair of tetralogy of fallot at the Uganda Heart Institute: a ten-year review of 30day mortality and morbidity

Rebecca Esther Khainza  1   2 , Michael Oketcho  3 , Twalib Aliku  4   5 , Judith Namuyonga  4   6 , Emma Ndagire  4 , Tom Mwambu  3 , Rwakaryebe Mbagga Muhoozi  3 , Bernard Obongnyinge  4 , Hilda Tumwebaze  4 , Nestor Mbabazi  4   7 , Teddy Akech  4 , Aisha Nakato  4 , Angelline Killen  4 , Geoffrey Oburu Ofumbi  8 , Peter Lwabi  4 , John Omagino  3 , Sulaiman Lubega  4
Affiliations

Primary surgical repair of tetralogy of fallot at the Uganda Heart Institute: a ten-year review of 30day mortality and morbidity

Rebecca Esther Khainza et al. BMC Cardiovasc Disord. .

Abstract

Background: Tetralogy of Fallot (TOF) is the most common form of cyanotic congenital heart disease (CHD) worldwide. It accounts for 7% of CHD cases in Uganda and leads to fatal outcomes in the long term without surgery. Surgery is often delayed in developing countries like Uganda due to limited resources.

Objective: This study aimed to determine the early surgical outcomes of patients with TOF who underwent primary intracardiac repair at the Uganda Heart Institute (UHI) and to identify factors associated.

Methodology: This retrospective chart review evaluated outcomes of primary TOF repair patients at UHI from February 2012 to October 2022. Patient outcomes were assessed from surgery until 30 days post-operation.

Results: Out of the 104 patients who underwent primary TOF repair at UHI, records of 88 patients (84.6%) were available for review. Males accounted for 48.9% (n = 43). The median age at the time of operation was 4 years (with an interquartile range of 2.5-8.0 years), ranging from 9 months to 16 years. Genetic syndromes were present in 5/88 (5.7%). These included 2 patients with trisomy 21, 2 with Noonan's, and 1 with 22q11.2 deletion syndrome. Early postoperative outcomes for patients included: residual ventricular septal defects in 35/88 (39.8%), right ventricular dysfunction in 33/88 (37.5%), residual pulmonary regurgitation in 27/88 (30.7%), residual right ventricular outflow tract obstruction in 27/88 (30.0%), pleural effusion in 24/88 (27.3%), arrhythmias in 24/88(27.3%), post-operative infections in 23/88(26.1%) and left ventricular systolic dysfunction in 9/88 (10.2%). Out of the children who underwent surgery after one year of age, 8% (7 children) died within the first 30 days. There was a correlation between mortality and post-operative ventilation time, cardiopulmonary bypass (CPB) time, aortic cross-clamp time, preoperative oxygen saturations, RV and LV dysfunction and the operating team.

Conclusion: The most frequent outcomes after surgery were residual ventricular septal defects and right ventricular failure. In our study, the 30-day mortality rate following TOF repair was 8%. Deceased patients had lower pre-operative oxygen levels, longer CPB and cross-clamp times, longer post-operative ventilation, RV/LV dysfunction, and were more likely operated by the local team.

Keywords: Early surgical outcomes; Post-operative ventilation time; Tetralogy of Fallot.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Echocardiographic findings of associated cardiac defects amongst patients who underwent primary TOF repair at UHI. ASD = atrial septal defect, PFO = patent foramen oval
See this image and copyright information in PMC

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