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Central Surgical Association

49th Annual Meeting

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Symptomatic Neonatal Tetralogy: Early Complete Repair vs. Staged Repair using Aorto-pulmonary Shunts
Srujan Ganta1, Katherine Price2, John Artrip3, Rohit Rao4, Howaida El-Said4, Denise Suttner4, Nathaly Sweeney4, *Tara Karamlou5, *John J. Nigro3
1Cardiothoracic Surgery, Rady Childrens Hospital, San Diego, California, United States, 2University of California San Diego School of Medicine, San Diego, California, United States, 3Cardiothoracic Surgery, University of California San Diego, San Diego, California, United States, 4Pediatrics, University of California San Diego, San Diego, California, United States, 5Cardiothoracic Surgery, Cleveland Clinic, Cleveland, California, United States

Objective:

Treatment for symptomatic neonates with Tetralogy of Fallot has evolved at our center from staged repair (SR) utilizing aorto-pulmonary shunts (APS) and subsequent late completion repair (LRep) towards complete early repair (ERep). The goal of this study is to compare early and intermediate term results of ERep to SR utilizing APS for symptomatic neonates with tetralogy of Fallot at our center.

Methods:

Retrospective chart review of all symptomatic neonates with TOF or similar morphology ≤ 4.1 kg at our institution (1/1/2010 - 11/30/2021) who required intervention yielded 59 patients.
The ERep cohort consisted of 30 patients and 29 patients received SR with APS followed by LRep.
Extensive multiple arterial pulmonary collaterals, ventricular hypoplasia and pulmonary artery arborization abnormalities were exclusion criteria. Abstracted data included demographics, imaging, operative reports, and patient care notes. Data were analyzed with descriptive statistics. Outcomes included survival, operative characteristics, post-op performance measures and complications. Follow up was complete at a median of 21 (IQR 4.1- 46) months for ERep and 52 (IQR 14 - 89) months for SR.


Results:

For the 59 patients, demographics and operative data are in Table 1. The transannular patch repair rate was not significantly different (57%, 41% ERep and SR respectively p= 0.44). Survival was 100% (30/30) in the ERep cohort with overall survival in the SR cohort of 86% (25/29) (p=0.038) Figure 1. The majority of mortalities (75%, 3/4) occurred post APS prior to LRep. There was no postoperative ECMO utilization for ERep versus 4/26 (15%) post-op ECMO runs with SR p=0.038. Hospital length of stay for ERep was 29.5 (15.5 – 58.3) days compared with 31 (21 – 56) days at APS followed by another 24.5 (11 – 52) days at LRep. At follow up, reintervention rate was higher with SR as 58%(15/26) required at least 1 re-intervention related to TOF repair versus 30%(9/30) of ERep patients with at least 1 re-intervention (p=0.039).

Conclusions:

ERep provides superior survival, less ECMO and resource utilization and less re-intervention at follow-up. ERep is an effective and versatile treatment for symptomatic neonates with tetralogy of Fallot and has evolved to become the primary repair strategy at our program.

Kaplan-Meier survival curve with number at risk listed below.

Patient data table. p-values represent comparison of ERep (early complete repair) to both APS (aorto-pulmonary shunting) and LRep (late repair) independently in the data table.


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