Outcomes of Neonatal Repair of Tetralogy of Fallot with Ductal Dependent Pulmonary Atresia

Chang-ha Lee ¹, Sungkyu Cho Cho ¹, Yong Jin Kim ¹, Eun Seok Choi ²

¹ Sejong General Hospital, Bucheon, Korea (South); ² Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (South);

Date, time and location: 2018.05.25 13:30, Exhibition area, 1st Floor. Zone – B

Abstract

Objective. Most of patients with tetralogy of Fallot with ductal dependent pulmonary atresia (TOF-PA) should be needed any intervention soon after birth, which includes one stage repair or palliation. We report the current outcomes of one stage repair in the neonates.

Methods. From May 2004 to April 2017, 28 neonates with TOF-PA underwent one stage repair. Median age and body weight at operation were 17 days (12 - 29 days) and 3.0 kg (2.2 - 4.2 kg). Median preoperative Nakata Index was 110 (62 - 189). According to the morphology, right ventricular outflow tract reconstruction (RVOTR) was performed by the interposition of a non-valved autopericardial roll (n = 13), transjunctional RVOTR (n = 10), RVOTR using the left atrial auricle (n = 3), and REV type RVOTR (n = 2).

Results. There is no hospital mortality and median hospital stay after repair was 19 days (6 - 112 days). Delayed sternal closure was performed in 5 patients. The median follow-up duration was 71 months (1.4 - 151 months). There were 2 late deaths and freedom from mortality was 92% at 10 years. During follow-up, various postoperative interventions were necessary in 23 patients, including a catheter intervention (n = 20) and reoperation (n = 15) mainly for the RVOT problems.

Conclusions. One stage repair in neonates with TOF-PA seems to be performed safely and with acceptable mid-term outcomes. However, various interventions after repair should be inevitable in many patients for optimizing the RVOT.