Alternative Repair Strategies for Ductal-Dependent Tetralogy of Fallot and Short-Term Postoperative Outcomes, A Multicenter Analysis

Matthew B. Steiner, Xinyu Tang, Jeffrey M. Gossett, Brandon W. Beam, Sadia Malik, Parthak Prodhan, Michael J. Angtuaco

Research output: Contribution to journalArticle

6 Scopus citations

Abstract

Our aim was to evaluate postoperative morbidity and mortality following initial intervention, comparing primary repair versus palliative shunt in the setting of ductal-dependent tetralogy of Fallot. When neonatal surgical intervention is required, controversy and cross-center variability exists with regard to surgical strategy. The multicenter Pediatric Health Information System database was queried to identify patients with TOF and ductal-dependent physiology, excluding pulmonary atresia. Eight hundred forty-five patients were included—349 (41.3 %) underwent primary complete repair, while 496 (58.7 %) underwent initial palliation. Palliated patients had significantly higher comorbid diagnoses of genetic syndrome and coronary artery anomalies. Primary complete repair patients had significantly increased morbidity across a number of variables compared to shunt palliation, but mortality rate was equal (6 %). Second-stage complete repair was analyzed for 285 of palliated patients, with median inter-stage duration of 231 days (175–322 days). In comparison to primary complete repairs, second-stage repairs had significantly decreased morbidity and mortality. However, cumulative morbidity was higher for the staged patients. Median adjusted billed charges were lower for primary complete repair ($363,554) compared to staged repair ($428,109). For ductal-dependent TOF, there is no difference in postoperative mortality following the initial surgery (6 %) whether management involves primary repair or palliative shunt. Although delaying complete repair by performing a palliative shunt is associated with a shift of much of the morbidity burden to outside of the newborn period, there is greater total postoperative morbidity and resource utilization associated with the staged approach.

Original languageEnglish (US)
Pages (from-to)177-189
Number of pages13
JournalPediatric Cardiology
Volume36
Issue number1
DOIs
StatePublished - Jan 1 2015

Keywords

  • Repair
  • Shunt
  • Surgery
  • Tetralogy of Fallot
  • Timing

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Cardiology and Cardiovascular Medicine

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