Early primary repair of tetralogy of fallot in neonates and infants less than four months of age.
BACKGROUND
The ideal age for correction of tetralogy of Fallot is still under discussion. The aim of this study was to analyze morbidity and mortality in patients who underwent early primary repair of tetralogy of Fallot at the age of less than 4 months and to assess whether neonates, who needed early repair within the first 4 weeks of life, faced an increased risk.


METHODS
From 1995 to 2006, 90 consecutive patients with tetralogy of Fallot and pulmonary stenosis underwent early primary repair. Patient charts were analyzed retrospectively for two groups: group A, 25 neonates younger than 28 days who needed early operation owing to duct-dependent pulmonary circulation or severe hypoxemia; and group B, 65 infants younger than 4 months of age who underwent elective early repair.


RESULTS
There was no 30-day mortality; late mortality was 2% after a median follow-up time of 4.7 years. Seven of 88 patients (8%) needed reoperation and twelve of 88 patients (14%) needed reintervention. Groups A and B did not differ significantly in terms of intensive care unit stay, days of mechanical ventilation, overall hospital stay, major or minor complications, or reoperation. Significant differences were found in a more frequent use of a transannular patch (p = 0.045) and more reinterventions (p = 0.046) in group A.


CONCLUSIONS
Early primary repair of tetralogy of Fallot can be performed safely and effectively in infants younger than 4 months of age and even in neonates younger than 28 days with duct-dependent pulmonary circulation or severe hypoxemia.
Tamesberger
Melanie I
MI
Department of Pediatric Cardiology, General Hospital Linz, Children's Heart Centre Linz, Linz, Austria.
Lechner
Evelyn
E
Mair
Rudolf
R
Hofer
Anna
A
Sames-Dolzer
Eva
E
Tulzer
Gerald
G
D000367:Age Factors; D006348:Cardiac Surgical Procedures / Q000379:methods / Q000401:mortality*; D002423:Cause of Death; D015331:Cohort Studies; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D008297:Male; D011183:Postoperative Complications / Q000401:mortality; D011336:Probability; D011666:Pulmonary Valve Stenosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric; D015996:Survival Rate; D013771:Tetralogy of Fallot / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome