Clinical Analysis of Staged Repair for Severe Tetralogy of Fallot in Children_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

HURui , JANGZhao-lei , LIUHao , ZHANGJun-wen , BAOChun-rong , DINGFang-bao ,  MEIJu

Department of Cardiothoracic Surgery, Xinhua hospital, Shanghai Jiaotong University, Shanghai 200092, P. R. China;

Corresponding author：

MEIJu, Email: ju_mei63@126.com

Keywords：

Tetralogy of Fallot; Cardiac surgery; Staged repair; Systemic-pulmonary shunt

DOI：

10.7507/1007-4848.20160211

Video：

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Objective To analyze the clinical effects of staged repair for severe tetralogy of Fallot (TOF), and to investigate a better individual treatment of TOF. Methods We retrospectively analyzed the clinical data of 110 children with TOF in our hospital from January 2009 through December 2014. The patients were divided into a severe TOF group (Group A, n=23) and a mild TOF group (Group B, n=87). In the group A, all 23 patients underwent staged surgery (modified Blalock-Taussig and radical operation of TOF). In the Group B, all 87 patients only received a radical operation of TOF. The patients' preoperative and postoperative arterial oxygen saturation, McGoon ratio, left ventricular end-diastolic volume index (LVEDVI), the results of perioperation and follow-up were compared. Results In the group A, there was no death after modified Blalock-Taussig (MBT). The median interval time between MBTs and radical operation was 9 months (ranged from 6.3 to 25.3 months). Compared with that before MBTs, the McGoon ratio and LVEDVI were significantly increased at the time of radical operation. And the pulmonary artery development and left ventricle volume reached the standard of radical operation of TOF (P < 0.01). After the radical operation, one patient died for pneumonia in the early postoperation period. In the group B, three patients died for low cardiac output syndrome during perioperation. There was no significant difference between the group A and the group B in in-hospital mortality, length of hospital stay, intensive care unit (ICU) stay, ventilation time, cardiopulmonary bypass time, aortic cross-clamp time, rate of using trans-annular repair path, or drainage of pleural fluid. Conclusion Staged repair of severe TOF is safe and effective for children, who are not suitable for one-stage radical operation. Severe TOF received staged repair can achieve the similar outcomes with that of mild TOF underwent one-stage radical operation.

Citation： HURui, JANGZhao-lei, LIUHao, ZHANGJun-wen, BAOChun-rong, DINGFang-bao, MEIJu. Clinical Analysis of Staged Repair for Severe Tetralogy of Fallot in Children. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2016, 23(9): 880-884. doi: 10.7507/1007-4848.20160211 Copy

1.	Kouchoukos NT, Doty DB. Ventricular septal defect with pulmonary stenosis or atresia. In:Kirklin/Barratt-Boyes (eds). Cardiac Surgery, 3rd ed. Philadelphia:Churchhill Livingstone, 2003. 946-973.
2.	Bailliard F, Anderson RH. Tetralogy of fallot. Orphanet J Rare Dis, 2009, 4:2.
3.	Barratt-Boyes BG, Neutze JM. Primary repair of tetralogy of Fallot in infancy using profound hypothermia with circulatory arrest and limited cardiopulmonary bypass:a comparison with conventional two stage management. Ann Surg, 1973, 178(4):406-411.
4.	梅举, 丁芳宝, 鲍春荣, 等.肺动脉发育不良的法洛四联症分期手术37例.中华胸心血管外科杂志, 2007, 23(5):292-294.
5.	Starr JP. Tetralogy of fallot:yesterday and today. World J Surg, 2010, 34(4):658-668.
6.	Khairy P, Landzberg MJ, Gatzoulis MA, et al. Value of programmed ventricular stimulation after tetralogy of fallot repair:a multicenter study. Circulation, 2004, 109(16):1994-2000.
7.	Pigula FA, Khalil PN, Mayer JE, et al. Repair of tetralogy of Fallot in neonates and young infants. Circulation, 1999, 100(19 Suppl):I157-I161.
8.	Galicia-Tornell M, Reyes-López A, Ruíz-González S, et al. Treatment of Fallot tetralogy with a transannular patch. Six years follow-up. Cir Cir, 2015, 83(6):478-484.
9.	Dorobantu DM, Pandey R, Sharabiani MT, et al. Indications and results of systemic to pulmonary shunts:results from a national database. Eur J Cardiothorac Surg, 2016, 49(6):1553-1563.
10.	方敏华, 王辉山, 汪曾炜, 等.体-肺动脉分流术后早期分流失效的危险因素分析.中国胸心血管外科临床杂志, 2012, 19(4):354-357.
11.	NaitoT, Fujita T, Yagihara T, et al. Usefulness of left ventricular volume in assessing tetralogy of Fallot for total correction. Am J Cardiol, 1985, 56(4):356-359.
12.	Dirks V, Pretre R, KnirschW, et al. Modified Blalock Taussig shunt:a not-so-simple palliative procedure. Eur J Cardiothorac Surg, 2013, 44(6):1096-1102.
13.	Jonas RA, Chief editor. Comprehensive surgical management of congenital heart disease. London:Arnold Oxford University Press, 2004. 279-293.
14.	赵科研, 候晓明, 柳克明, 等.法洛四联症并小左室行体肺分流术效果分析.中国综合临床, 2010, 26(8):849-851.
15.	Shauq A, Agarwal V, Karunaratne A, et al. Surgical approaches to the blalock shunt:does the approach matter? Heart Lung Circ, 2010, 19(8):460-464.
16.	Godart F, Qureshi SA, Simha A, et al. Effects of modified and classic Blalock-Taussig shunts on the pulmonary arterial tree. Ann Thorac Surg, 1998, 66(2): 512-518.
17.	Rohit MK, Vadivelu R, Khandelwal N, et al. Post Blalock-Taussig shunt mediastinal mass-a single shadow with two different destinies. Indian Heart J, 2014, 66(2):227-230.
18.	Park CS, Kim WH, Kim GB, et al. Symptomatic young infants with tetralogy of fallot:one-stage versus staged repair. J Card Surg, 2010, 25(4): 394-399.
19.	Kim H, Sung SC, Chang YH, et al. Outcome of staged repair of tetralogy of fallot with pulmonary atresia and a ductus-dependent pulmonary circulation:should primary repair be considered? Korean J Thorac Cardiovasc Surg, 2011, 44(6):392-398.

1. Kouchoukos NT, Doty DB. Ventricular septal defect with pulmonary stenosis or atresia. In:Kirklin/Barratt-Boyes (eds). Cardiac Surgery, 3rd ed. Philadelphia:Churchhill Livingstone, 2003. 946-973.
2. Bailliard F, Anderson RH. Tetralogy of fallot. Orphanet J Rare Dis, 2009, 4:2.
3. Barratt-Boyes BG, Neutze JM. Primary repair of tetralogy of Fallot in infancy using profound hypothermia with circulatory arrest and limited cardiopulmonary bypass:a comparison with conventional two stage management. Ann Surg, 1973, 178(4):406-411.
4. 梅举, 丁芳宝, 鲍春荣, 等.肺动脉发育不良的法洛四联症分期手术37例.中华胸心血管外科杂志, 2007, 23(5):292-294.
5. Starr JP. Tetralogy of fallot:yesterday and today. World J Surg, 2010, 34(4):658-668.
6. Khairy P, Landzberg MJ, Gatzoulis MA, et al. Value of programmed ventricular stimulation after tetralogy of fallot repair:a multicenter study. Circulation, 2004, 109(16):1994-2000.
7. Pigula FA, Khalil PN, Mayer JE, et al. Repair of tetralogy of Fallot in neonates and young infants. Circulation, 1999, 100(19 Suppl):I157-I161.
8. Galicia-Tornell M, Reyes-López A, Ruíz-González S, et al. Treatment of Fallot tetralogy with a transannular patch. Six years follow-up. Cir Cir, 2015, 83(6):478-484.
9. Dorobantu DM, Pandey R, Sharabiani MT, et al. Indications and results of systemic to pulmonary shunts:results from a national database. Eur J Cardiothorac Surg, 2016, 49(6):1553-1563.
10. 方敏华, 王辉山, 汪曾炜, 等.体-肺动脉分流术后早期分流失效的危险因素分析.中国胸心血管外科临床杂志, 2012, 19(4):354-357.
11. NaitoT, Fujita T, Yagihara T, et al. Usefulness of left ventricular volume in assessing tetralogy of Fallot for total correction. Am J Cardiol, 1985, 56(4):356-359.
12. Dirks V, Pretre R, KnirschW, et al. Modified Blalock Taussig shunt:a not-so-simple palliative procedure. Eur J Cardiothorac Surg, 2013, 44(6):1096-1102.
13. Jonas RA, Chief editor. Comprehensive surgical management of congenital heart disease. London:Arnold Oxford University Press, 2004. 279-293.
14. 赵科研, 候晓明, 柳克明, 等.法洛四联症并小左室行体肺分流术效果分析.中国综合临床, 2010, 26(8):849-851.
15. Shauq A, Agarwal V, Karunaratne A, et al. Surgical approaches to the blalock shunt:does the approach matter? Heart Lung Circ, 2010, 19(8):460-464.
16. Godart F, Qureshi SA, Simha A, et al. Effects of modified and classic Blalock-Taussig shunts on the pulmonary arterial tree. Ann Thorac Surg, 1998, 66(2): 512-518.
17. Rohit MK, Vadivelu R, Khandelwal N, et al. Post Blalock-Taussig shunt mediastinal mass-a single shadow with two different destinies. Indian Heart J, 2014, 66(2):227-230.
18. Park CS, Kim WH, Kim GB, et al. Symptomatic young infants with tetralogy of fallot:one-stage versus staged repair. J Card Surg, 2010, 25(4): 394-399.
19. Kim H, Sung SC, Chang YH, et al. Outcome of staged repair of tetralogy of fallot with pulmonary atresia and a ductus-dependent pulmonary circulation:should primary repair be considered? Korean J Thorac Cardiovasc Surg, 2011, 44(6):392-398.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Clinical Analysis of Staged Repair for Severe Tetralogy of Fallot in Children

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