title: Alternative repair strategies for ductal-dependent tetralogy of fallot and short-term postoperative outcomes, a multicenter analysis.
abstract: Our aim was to evaluate postoperative morbidity and mortality following initial intervention, comparing primary repair versus palliative shunt in the setting of ductal-dependent tetralogy of Fallot. When neonatal surgical intervention is required, controversy and cross-center variability exists with regard to surgical strategy. The multicenter Pediatric Health Information System database was queried to identify patients with TOF and ductal-dependent physiology, excluding pulmonary atresia. Eight hundred forty-five patients were included-349 (41.3%) underwent primary complete repair, while 496 (58.7%) underwent initial palliation. Palliated patients had significantly higher comorbid diagnoses of genetic syndrome and coronary artery anomalies. Primary complete repair patients had significantly increased morbidity across a number of variables compared to shunt palliation, but mortality rate was equal (6%). Second-stage complete repair was analyzed for 285 of palliated patients, with median inter-stage duration of 231 days (175-322 days). In comparison to primary complete repairs, second-stage repairs had significantly decreased morbidity and mortality. However, cumulative morbidity was higher for the staged patients. Median adjusted billed charges were lower for primary complete repair ($363,554) compared to staged repair ($428,109). For ductal-dependent TOF, there is no difference in postoperative mortality following the initial surgery (6%) whether management involves primary repair or palliative shunt. Although delaying complete repair by performing a palliative shunt is associated with a shift of much of the morbidity burden to outside of the newborn period, there is greater total postoperative morbidity and resource utilization associated with the staged approach.
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, One Children's Way, Little Rock, AR, 72202, USA, mbs310@aol.com.
authors.forename: Matthew B
authors.initials: MB
authors.lastname: Steiner
authors.forename: Xinyu
authors.initials: X
authors.lastname: Tang
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Gossett
authors.forename: Brandon W
authors.initials: BW
authors.lastname: Beam
authors.forename: Sadia
authors.initials: S
authors.lastname: Malik
authors.forename: Parthak
authors.initials: P
authors.lastname: Prodhan
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Angtuaco
mesh_terms: D006348:Cardiac Surgical Procedures / Q000191:economics / Q000379:methods*; D015897:Comorbidity; D005260:Female; D017722:Hospital Charges; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D010166:Palliative Care / Q000191:economics / Q000379:methods*; D012086:Reoperation; D013771:Tetralogy of Fallot / Q000601:surgery*; D016896:Treatment Outcome