Abstract
Objective
To report the early postoperative outcomes in adults with tetralogy of Fallot (TOF)
undergoing cardiac surgery and to identify patient factors associated with complications.
Patients and Methods
We performed a single-institution retrospective review of adults with TOF who underwent
cardiac surgery from January 8, 2008, through June 21, 2018. Patients’ characteristics,
preoperative imaging, surgical interventions, outcomes, and complications were analyzed.
Results
There were 219 adults with TOF (mean age, 40 years; range, 18-83 years; 88 [40%] female)
in the study. Surgical interventions included repair or replacement of the pulmonary
valve (n=199 [91%]), tricuspid valve (n=70 [32%]), mitral valve (n=13 [5.9%]), and
aortic valve (n=8 [3.7%]). Three patients (1.4%) underwent first-time TOF repair.
The 30-day mortality rate was 1.4% (n=3). Early postoperative complications occurred
in 66 (30%) and included arrhythmias requiring treatment, dialysis requirement, liver
dysfunction, respiratory failure, infection, reoperation, cardiac arrest, mechanical
circulatory support, and death. Multivariate analysis found older age at current surgery
(odds ratio [OR], 1.04 per year; 95% CI, 1.01 to 1.06; P<.001), longer cardiopulmonary bypass time (OR, 1.01 per minute; 95% CI, 1.01 to 1.02;
P<.001), right ventricular systolic dysfunction (OR, 1.31; 95%, CI 1.02 to 1.69; P=.03), diabetes mellitus (OR, 3.50; 95% CI, 1.20 to 10.2; P=.02), and history of initial palliative surgery (OR, 1.99; 95% CI, 1.01 to 3.91;
P=.05) as independent predictors of complications.
Conclusion
Surgical interventions for adult patients with TOF can be performed with low early
morbidity and mortality. Clinical characteristics and preoperative testing parameters
can predict risk for complications in the postoperative period.
Abbreviations and Acronyms:
CHD (congenital heart disease), CPB (cardiopulmonary bypass), ECMO (extracorporeal membrane oxygenation), EDV (end-diastolic volume), EF (ejection fraction), IQR (interquartile range), LV (left ventricular), MRI (magnetic resonance imaging), OR (odds ratio), POD (postoperative day), PVR (pulmonary valve replacement), RV (right ventricular), RVSP (right ventricular systolic pressure), TOF (tetralogy of Fallot), TR (tricuspid regurgitation)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: August 16, 2021
Footnotes
Potential Competing Interests: The authors report no competing interests.
Identification
Copyright
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