Risk factors for morbidity in infants undergoing tetralogy of fallot repair.
BACKGROUND
Primary repair of tetralogy of Fallot (TOF) has low surgical mortality, but some patients still experience significant postoperative morbidity.


OBJECTIVE
To review our institutional experience with primary TOF repair, and identify predictors of intensive care unit (ICU) morbidity.


METHODS
Medium-sized pediatric cardiology program. Retrospective study.


METHODS
We retrospectively reviewed all the patients with TOF and pulmonic stenosis who underwent primary repair in infancy at our institution from January 2001 to December 2012. Preoperative, operative, and postoperative demographic and morphologic data were analyzed. ICU morbidity was defined as prolonged ICU stay (≥7 days), and/or prolonged duration of mechanical ventilation (≥48 h).


METHODS
Multiple logistic regression analysis.


RESULTS
Ninety-seven patients underwent primary surgical repair during the study period. The median age was 4.9 months (1-9 months) and the median weight was 5.3 kg (3.1-9.8 kg). There was no early surgical mortality. Incidence of junctional ectopic tachycardia (JET) and persistent complete heart block was 2 and 1%, respectively. The median length of ICU stay was 6 days (2-21 days) and median duration of mechanical ventilation was 19 h (0-136 h). By multiple regression analysis, age and weight were independent predictors of length of ICU stay, while surgical era was an independent predictor of duration of mechanical ventilation.


CONCLUSIONS
Primary TOF repair is a safe procedure with low mortality and morbidity in a medium-sized program with outcomes comparable to national standards. Age and weight at the time of surgery remain significant predictors of morbidity.
Division of Pediatric Cardiology, Mount Sinai Hospital, One Gustave Levy Place, New York, NY.
Alexander C
AC
Egbe
Division of Pediatric Cardiology, Mount Sinai Hospital, One Gustave Levy Place, New York, NY.
Alexander J
AJ
Mittnacht
Division of Pediatric Cardiology, Mount Sinai Hospital, One Gustave Levy Place, New York, NY.
Khanh
K
Nguyen
Division of Pediatric Cardiology, Mount Sinai Hospital, One Gustave Levy Place, New York, NY.
Umesh
U
Joashi
Morbidity; outcomes; pediatric; tetralogy of fallot; ventilation