title: Right Ventricular Outflow Tract Stenting in Tetralogy of Fallot Infants With Risk Factors for Early Primary Repair.
abstract: Tetralogy of Fallot with cyanosis requiring surgical repair in early infancy reflects poor anatomy and is associated with more clinical instability and longer hospitalization than those who can be electively repaired later. We bridged symptomatic infants with risk factors for early primary repair by right ventricular outflow tract stenting (stent).
  
  
  
  Four groups of tetralogy of Fallot with confluent central pulmonary arteries were studied: stent group (n=42), primary repair (aged <3 months) with pulmonary stenosis (early-PS group; n=44), primary repair (aged <3 months) with pulmonary atresia (early-PA group; n=49), and primary repair between 3 and 11 months of age (surg>3mo group; n=45). Stent patients had the smallest pulmonary arteries with a median (95% credible intervals) Nakata index (mm2/m2) of 79 (66-85) compared with the early-PA 139 (129-154), early-PS 136 (121-153), and surg>3mo 167 (153-200) groups. Only stent infants required unifocalization of aortopulmonary collaterals (17%). Stent and early-PA infants had younger age and lower weight than early-PS infants. Stent infants had the most multiple comorbidities. Stenting allowed deferral of complete surgical repair to an age (6 months), weight (6.3 [5.8-7.0] kg), and Nakata index (147 [132-165]) similar to the low-risk surg>3mo group. The 3 early treatment groups had similar intensive care unit/hospital stays and high reintervention rates in the first 12 months after repair, compared with the surg>3mo group.
  
  
  
  Right ventricular outflow tract stenting of symptomatic tetralogy of Fallot with poor anatomy (small pulmonary arteries) and adverse factors (multiple comorbidities, low weight) relieves cyanosis and defers surgical repair. This allowed pulmonary arterial and somatic growth with clinical results comparable to early surgical repair in more favorable patients.
authors.affiliation: From the Labatt Family Heart Centre, Division of Cardiology and Division of Cardiac Surgery, The Hospital for Sick Children, University of Toronto School of Medicine, Ontario, Canada.
authors.forename: Juan Pablo
authors.initials: JP
authors.lastname: Sandoval
authors.affiliation: From the Labatt Family Heart Centre, Division of Cardiology and Division of Cardiac Surgery, The Hospital for Sick Children, University of Toronto School of Medicine, Ontario, Canada.
authors.forename: Rajiv R
authors.initials: RR
authors.lastname: Chaturvedi
authors.affiliation: From the Labatt Family Heart Centre, Division of Cardiology and Division of Cardiac Surgery, The Hospital for Sick Children, University of Toronto School of Medicine, Ontario, Canada.
authors.forename: Lee
authors.initials: L
authors.lastname: Benson
authors.affiliation: From the Labatt Family Heart Centre, Division of Cardiology and Division of Cardiac Surgery, The Hospital for Sick Children, University of Toronto School of Medicine, Ontario, Canada.
authors.forename: Gareth
authors.initials: G
authors.lastname: Morgan
authors.affiliation: From the Labatt Family Heart Centre, Division of Cardiology and Division of Cardiac Surgery, The Hospital for Sick Children, University of Toronto School of Medicine, Ontario, Canada.
authors.forename: Glen
authors.initials: G
authors.lastname: Van Arsdell
authors.affiliation: From the Labatt Family Heart Centre, Division of Cardiology and Division of Cardiac Surgery, The Hospital for Sick Children, University of Toronto School of Medicine, Ontario, Canada.
authors.forename: Osami
authors.initials: O
authors.lastname: Honjo
authors.affiliation: From the Labatt Family Heart Centre, Division of Cardiology and Division of Cardiac Surgery, The Hospital for Sick Children, University of Toronto School of Medicine, Ontario, Canada.
authors.forename: Christopher
authors.initials: C
authors.lastname: Caldarone
authors.affiliation: From the Labatt Family Heart Centre, Division of Cardiology and Division of Cardiac Surgery, The Hospital for Sick Children, University of Toronto School of Medicine, Ontario, Canada. kyong-jin.lee@sickkids.ca.
authors.forename: Kyong-Jin
authors.initials: KJ
authors.lastname: Lee
mesh_terms: D000367:Age Factors; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation*; D003490:Cyanosis / Q000209:etiology; D061345:Early Medical Intervention; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D011183:Postoperative Complications / Q000209:etiology; D011651:Pulmonary Artery / Q000002:abnormalities; D012307:Risk Factors; D015607:Stents; D013771:Tetralogy of Fallot / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D014694:Ventricular Outflow Obstruction / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*
keywords: cardiac catheterization; cyanosis; risk assessment; stent; tetralogy of Fallot