Early Outcomes after Total Correction for Tetralogy of Fallot Patients at Department of Cardiothoracic and Vascular Surgery Amiri Medical Complex Kabul-Afghanistan (A Single Center Study)

Tetralogy of Fallot is the most common cyanotic congenital heart disease. The first complete repair of tetralogy of Fallot was successfully performed by C. Walton Lillehi and his team in 1954, but first total correction performed at department of cardiothoracic and vascular surgery Amiri Medical Complex Kabul Afghanistan in 2015, despite some advocates of routine two-stage repair in infancy, during the early 1990s reports documented improve early results with primary repair was associated with improved outcome compared to a two-stage approach. The purpose of this study was to analyze the early postoperative result in total correction for the first time in Afghanistan. Method: The purpose of this study was to evaluate the early outcome after total correction in 180 consecutive patients with a mean age of 5-30 years who underwent total correction surgery in a single center Amiri Medical Complex, Kabul, Afghanistan between August 2015 and October 2018. 8 patients had initial palliative operations (modified BT shunt) in outside centers and referred to us for total correction. The trans annular pericardial patch was inserted in 133(73.8%) patients. 32(17.7%) patients repaired by trans atrial total correction (ventricular septal defect, right ventricular outflow tract muscle band resection and pulmonary valvotomy done through the right atrium ) for 5(2.7%) patients with absent pulmonary valve, monocuspid and bicuspid pulmonary valve reconstructed with a pericardial patch. Result: Mean follow up was (1-3) months postoperatively, the mortality rate was (8.8%). Most of the patients who repaired with trans annular patch had free pulmonary valve regurgitation post-operative period by transthoracic echocardiography 26 patients had the excellent function of their native repaired pulmonary valve and monocusp, bicuspid reconstructed pulmonary valve. The peak gradient of right ventricular outflow tract was between 10 to 35 mmHg postoperatively. 22 patients had small (tiny) residual ventricular septal defect and none of the patients had complete heart block (0%). Conclusion: Total correction for tetralogy of Fallot patients may have low operative mortality and provide excellent short and long term survival in modern centers; this experience suggests that total correction for tetralogy of Fallot patients would have good short term outcomes in developed countries.