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. 2024 Apr 11:19:241-256.
doi: 10.1016/j.xjon.2024.04.003. eCollection 2024 Jun.

Young infants with symptomatic tetralogy of Fallot: Shunt or primary repair?

Xin Tao Ye  1   2   3 , Soichiro Henmi  4 , Edward Buratto  1   2   3 , Mitchell C Haverty  4 , Can Yerebakan  4   5 , Tyson Fricke  1   2   3 , Christian P Brizard  1   2   3   6 , Yves d'Udekem  4   5 , Igor E Konstantinov  1   2   3   6
Affiliations

Young infants with symptomatic tetralogy of Fallot: Shunt or primary repair?

Xin Tao Ye et al. JTCVS Open. .

Abstract

Objectives: The optimal treatment strategy for symptomatic young infants with tetralogy of Fallot (TOF) is unclear. We sought to compare the outcomes of staged repair (SR) (shunt palliation followed by second-stage complete repair) versus primary repair (PR) at 2 institutions that have exclusively adopted each strategy.

Methods: We performed propensity score-matched comparison of 143 infants under 4 months of age who underwent shunt palliation at one institution between 1993 and 2021 with 122 infants who underwent PR between 2004 and 2018 at another institution. The primary outcome was mortality. Secondary outcomes were postoperative complications, durations of perioperative support and hospital stays, and reinterventions. Median follow-up was 8.3 years (interquartile range, 8.1-13.4 years).

Results: After the initial procedure, hospital mortality (shunt, 2.8% vs PR, 2.5%; P = .86) and 10-year survival (shunt, 95%; 95% confidence interval [CI], 90%-98% vs PR, 90%; 95% CI, 81%-95%; P = .65) were similar. The SR group had a greater risk of early reinterventions but similar rates of late reinterventions. Propensity score matching yielded 57 well-balanced pairs. In the matched cohort, the SR group had similar freedom from reintervention (55%; 95% CI, 39%-68% vs 59%; 95% CI, 43%-71%; P = .85) and greater survival (98%; 95% CI, 88%-99.8% vs 85%; 95% CI, 69%-93%; P = .02) at 10 years, as the result of more noncardiac-related mortalities in the PR group.

Conclusions: In symptomatic young infants with TOF operated at 2 institutions with exclusive treatment protocols, the SR strategy was associated with similar cardiac-related mortality and reinterventions as the PR strategy at medium-term follow-up.

Keywords: infants; palliation; surgery; symptomatic; tetralogy of Fallot.

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Conflict of interest statement

Dr Brizard has served on the advisory board of Admedus. All other authors reported no conflicts of interest. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest.

Figures

None
Reintervention-free survival after shunt palliation versus primary repair for symptomatic TOF.
Figure 1
Figure 1
Unmatched comparison of (A) survival and (B) freedom from reintervention after index procedure, stratified according to treatment strategy. CI, Confidence interval.
Figure 2
Figure 2
Unmatched comparison of freedom from reintervention for (A) right ventricular outflow tract obstruction (RVOTO); (B) right ventricular (RV) dilation; (C) pulmonary artery stenosis (PAS); and (D) pulmonary valve replacement (PVR) after complete repair, stratified according to treatment strategy. TOF, Tetralogy of Fallot; CI, confidence interval.
Figure 3
Figure 3
Propensity score–matched comparison of (A) survival and (B) freedom from reintervention after index procedure, stratified according to treatment strategy. CI, Confidence interval.
Figure E1
Figure E1
Cohort flow diagram depicting patient disposition in the staged repair and primary repair groups. IQR, Interquartile range.
Figure E2
Figure E2
Propensity score-matched comparison of freedom from reintervention for (A) right ventricular outflow tract obstruction (RVOTO); (B) right ventricular (RV) dilation; (C) pulmonary artery stenosis (PAS); and (D) pulmonary valve replacement (PVR) after complete repair, stratified according to treatment strategy. 95% CI. TOF, Tetralogy of Fallot; CI, confidence interval.
Figure E3
Figure E3
Covariate balance plot for determining adequacy of propensity score matching. Values on the horizontal axis represent the standardized difference between each group. Triangles: standardized difference before matching; squares: standardized difference after matching. RPA, Right pulmonary artery; LPA, left pulmonary artery; PV, pulmonary valve.
See this image and copyright information in PMC

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