Primary repair of tetralogy of Fallot in infants: transatrial/transpulmonary or transventricular approach.
OBJECTIVE
Right ventricular (RV) dysfunction is a significant cause of morbidity and mortality after surgical correction of tetralogy of Fallot (TOF). Transatrial/transpulmonary repair avoids a ventriculotomy (in contrast to the transventricular approach) in order to preserve the structure and function of the right ventricle. We performed a pilot prospective randomized controlled trial in infants with TOF undergoing primary repair.


METHODS
A pilot prospective controlled clinical trial was conducted in infants with TOF undergoing primary repair between January 2008 and December 2009. One hundred and six patients were recruited in the trial and divided into a transatrial-transpulmonary approach group (Group A; n = 53) and a transventricular approach group (Group B; n = 53), depending on the different surgical techniques used.


RESULTS
Preoperative patient characteristics and procedure-related variables were similar. There were no deaths in Group A, while two patients died in Group B. There were significant differences in cardiopulmonary bypass time (95.02 ± 23.8 vs. 85.23 ± 22.63 minutes, p = 0.032), cross-clamp time (69.4 ± 10.36 vs. 61.17 ± 9.38 minutes, p = 0.035), inotropic support (1.63 ± 0.97 vs. 2.1 ± 1.09 days, p = 0.02), intubation time (26.62 ± 12.48 vs. 33.02 ± 17.55 hours, p = 0.033), duration of stay in the intensive care unit (ICU) (2.25 ± 1.28 vs. 2.85 ± 1.46 days, p = 0.026), and the incidence of arrhythmia [3 patients (5.7%) vs. 10 patients (18.9%), p = 0.038]. No significant differences in right/left ventricular pressure ratio and hospital stay were observed.


CONCLUSIONS
Transatrial/transpulmonary repair of TOF is associated with excellent surgical results and immediately follow-up.
Department of Cardiovascular Surgery, Xinqiao Hospital, Third Military Medical University, Chongqing, China.
Guolin
G
Sun
Xuefeng
X
Wang
Jinjin
J
Chen
Ruiyan
R
Ma
Fuping
F
Li
Lin
L
Chen
Yingbin
Y
Xiao
D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D011183:Postoperative Complications / Q000517:prevention & control; D011446:Prospective Studies; D013536:Suture Techniques; D013771:Tetralogy of Fallot / Q000601:surgery*; D018497:Ventricular Dysfunction, Right / Q000517:prevention & control
infancy; tetralogy of Fallot; transatrial/transpulmonary; transventricular