Results of Urgent Interventions in Patients with Tetralogy of Fallot Within the First Three Months of Age.

Abstract

BackgroundMost Tetralogy of Fallot (TOF) patients undergo reparative surgery at approximately 6 months of age. However, some patients experience severe cyanotic spells in the neonatal or infancy period requiring urgent procedures to increase pulmonary blood flow.MethodsRetrospective review of patients younger than 3 months with TOF who needed interventions between 2015 and 2021. In total, 42 babies required urgent procedures (19 surgical procedures in group 1 and 23 transcatheter interventions in group 2).ResultsMedian age and weight were 38 days (interquartile range [IQR] 19-70 days) and 3.7 Kg (IQR 3.4-4.2 Kg) in group 1 and 29 days (19-43 days) and 3.2 Kg (2.9-3.7 kg) in group 2, respectively. Group 1 had nine full surgical repairs (9/42, 21.4%), eight modified Blalock-Taussig-Thomas (BTT) shunts (8/42, 19%), one isolated transannular patch (1/42, 2.4%) and one right ventricle to pulmonary artery conduit (1/42, 2.4%). Six of the patients in Group 1 had their surgical intervention after an abandoned transcatheter procedure. Group 2 included nine patent ductus arteriosus (PDA) stents (9/42, 21.4%), nine right ventricular outflow tract (RVOT) stents (9/42, 21.4%), three pulmonary valve balloon dilatations (3/42, 7%) and two RVOT balloon dilatations (2/42, 4.8%). Median intensive care unit and hospital stays were 4 days (3-8) and 9 days (7.5-20) in group 1, compared with 1 day (1-1.5) and 5 days (3-15.5) in group 2, respectively. One patient (1/42, 2.4%) in group 1 needed reintervention before full repair, while five patients (5/42, 11.9%) in group 2 required further catheter reinterventions before full repair.ConclusionIn TOF patients requiring urgent early intervention, when catheter or surgical approach are tailored according to the anatomical substrate, excellent outcomes are expected. In patients with favorable anatomy, we believe that full repair can be performed as a primary procedure with good early and mid-term outcomes.