Abstract 16954: Staged versus Complete Repair in the Symptomatic Neonate With Tetralogy of Fallot: in Search of the Optimal Strategy
Objective: To compare perioperative and intermediate outcomes in the symptomatic neonate with tetralogy of Fallot (TOF) undergoing complete repair versus a neonatal palliative procedure followed by a complete repair.
Methods: A retrospective cohort study of symptomatic neonates with TOF who had a complete repair (Group 1, n=111) or palliation followed by complete repair (Group 2, n= 28) from 2000 to 2013 at our center. Outcomes were compared at four points: the admission for neonatal intervention (Group 1 vs 2A), the admission for complete repair (Group 1 vs 2B), the single vs combined surgical admissions to achieve a complete repair (Group 1 vs Group 2A+2B), and cumulative events 2 years post complete repair.
Results: Demographics, surgical approach and mortality were similar between Groups. At the time of the neonatal procedure, Group 1 was exposed to cardiopulmonary bypass (CPB) and deep hypothermic circulatory arrest (DHCA) more frequently than Group 2A. As compared to Group 1, Group 2 had shorter duration of intubation, ICU care, and post-procedure length of stay during the neonatal procedure and at complete repair. The combined admissions for Group 2 showed no difference in the total duration of intubation, ICU care or total length of hospital stay as compared to Group 1. Following complete repair, the number of subjects who required re-intervention and the number of re-hospitalizations per Group were similar though Group 2 had more total number of surgeries.
Conclusions: In the largest cohort of symptomatic neonates with TOF to date, both strategies seemingly ultimately offer similar cardiac outcomes. Even though it requires one additional surgical procedure, the staged approach might offer long term neurodevelopmental advantages by minimizing exposure to CPB, DHCA and perioperative complications in the neonatal period without incurring substantially longer cumulative days of ICU or hospital care.
Author Disclosures: J. Bailey: None. L. Mercer-Rosa: None. C. Mascio: None. O. Elci: None. E. Goldmuntz: None.
- © 2016 by American Heart Association, Inc.