Alternative Repair Strategies for Ductal-Dependent Tetralogy of Fallot and Short-Term Postoperative Outcomes, A Multicenter Analysis

详细信息    查看全文

• 作者：Matthew B. Steiner ; Xinyu Tang ; Jeffrey M. Gossett ; Brandon W. Beam…
• 关键词：Tetralogy of Fallot ; Surgery ; Repair ; Shunt ; Timing
• 刊名：Pediatric Cardiology
• 出版年：2015
• 出版时间：January 2015
• 年：2015
• 卷：36
• 期：1
• 页码：177-189
• 全文大小：544 KB
• 参考文献：1. Al Habib HF, Jacobs JP, Mavroudis C, Tchervenkov CI, O’Brien SM, Mohammadi S et al (2010) Contemporary patterns of management of tetralogy of Fallot: data from the Society of Thoracic Surgeons Database. Ann Thorac Surg 90:813-19; discussion 819-820 <a class="external" href="http://dx.doi.org/10.1016/j.athoracsur.2010.03.110" target="_blank" title="It opens in new window">CrossRefa>
  2. Centers for Disease Control and Prevention, National Center for Health Statistics (2013) International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). <a href="http://www.cdc.gov/nchs/icd/icd9cm.htm" class="a-plus-plus">http://www.cdc.gov/nchs/icd/icd9cm.htma>. Accessed 3 May 2013
  3. Consumer Price Index, All Urban Consumers (2013) U.S. Department of Labor, Bureau of Labor Statistics. <a href="http://www.bls.gov/cpi/" class="a-plus-plus">http://www.bls.gov/cpi/a>. Accessed 27 Aug 2013
  4. CTC Resources (2013) Child Health Corporation of America. <a href="http://www.chca.com/index_flash.html" class="a-plus-plus">http://www.chca.com/index_flash.htmla>. Accessed 3 May 2013
  5. Fermanis GG, Ekangaki AK, Salmon AP, Keeton BR, Shore DF, Lamb RK et al (1992) Twelve year experience with the modified Blalock–Taussig shunt in neonates. Eur J Cardiothorac Surg 6:586-89 <a class="external" href="http://dx.doi.org/10.1016/1010-7940(92)90131-G" target="_blank" title="It opens in new window">CrossRefa>
  6. Gladman G, McCrindle BW, Williams WG, Freedom RM, Benson LN (1997) The modified Blalock-Taussig shunt: clinical impact and morbidity in Fallot’s tetralogy in the current era. J Thorac Cardiovasc Surg 114:25-0 <a class="external" href="http://dx.doi.org/10.1016/S0022-5223(97)70113-2" target="_blank" title="It opens in new window">CrossRefa>
  7. Improved National Prevalence Estimates for (2006) 18 Selected Major Birth Defects—United States 1999-001. MMWR Morb Mortal Wkly Rep 54:1301-305
  8. Kanter KR, Kogon BE, Kirshbom PM, Carlock PR (2010) Symptomatic neonatal tetralogy of Fallot: repair or shunt? Ann Thorac Surg 89(3):858-63 <a class="external" href="http://dx.doi.org/10.1016/j.athoracsur.2009.12.060" target="_blank" title="It opens in new window">CrossRefa>
  9. Mulder TJ, Pyles LA, Stolfi A, Pickoff AS, Moller JH (2002) A Multicenter analysis of the choice of initial surgical procedure in tetralogy of Fallot. Pediatr Cardiol 23:580-86 <a class="external" href="http://dx.doi.org/10.1007/s00246-001-0061-8" target="_blank" title="It opens in new window">CrossRefa>
  10. Owner Hospitals (2013) Child Health Corporation of America. <a href="http://www.chca.com/index_flash.html" class="a-plus-plus">http://www.chca.com/index_flash.htmla>. Accessed 3 May 2013
  11. Park CS, Kim WH, Kim GB, Bae EJ, Kim JT, Lee JR, Kim YJ (2010) Symptomatic young infants with tetralogy of Fallot: one-stage vs staged repair. J Card Surg 25:394-99 <a class="external" href="http://dx.doi.org/10.1111/j.1540-8191.2010.01053.x" target="_blank" title="It opens in new window">CrossRefa>
  12. Parry AJ, McElhinney DB, Kung GC, Reddy VM, Brook MM, Hanley FL (2000) Elective primary repair of acyanotic tetralogy of Fallot in early infancy: overall outcome and impact on the pulmonary valve. J Am Coll Cardiol 36:2279-283 <a class="external" href="http://dx.doi.org/10.1016/S0735-1097(00)00989-X" target="_blank" title="It opens in new window">CrossRefa>
  13. Pigula FA, Khalil PN, Mayer JE, del Nido PJ, Jonas RA (1999) Repair of tetralogy of Fallot in neonates and young infants. Circulation 100(19 Suppl):157-61
  14. Sousa Uva M, Chardigny MC, Galetti L, Lacour Gayet F, Roussin R, Serraf A et al (1995) Surgery for tetralogy of Fallot at less than six months of age. Is palliation “old-fashioned- Eur J Cardiothorac Surg 9:453-59; discussion 459-60 <a class="external" href="http://dx.doi.org/10.1016/S1010-7940(05)80082-X" target="_blank" title="It opens in new window">CrossRefa>
  15. Steiner MB, Tang X, Gossett JM, Malik S, Prodhan P (2014) Timing of complete repair of non-ductal-dependent tetralogy of Fallot and short-term postoperative outcomes, a multicenter analysis. J Thoracic Cardiovasc Surg 147:1299-305 <a class="external" href="http://dx.doi.org/10.1016/j.jtcvs.2013.06.019" target="_blank" title="It opens in new window">CrossRefa>
  16. Talner CN (1980) Report of the New England Regional Infant Cardiac Program. Pediatrics 65(suppl):375-61
  17. Ungerleider RM, Kanter RJ, O’Laughlin M, Bengur AR, Andreson PA, Herlong JR et al (1997) Effect of repair strategy on hospital cost for infants with tetralogy of Fallot. Ann Surg 225:779-83; discussion 783-84 <a class="external" href="http://dx.doi.org/10.1097/00000658-199706000-00015" target="_blank" title="It opens in new window">CrossRefa>
  18. Van Arsdell GS, Maharaj GS, Tom J, Rao VK, Coles JG, Freedom RM et al (2000) What is the optimal age for repair of tetralogy of Fallot? Circulation 102(
• 刊物类别：Medicine
• 刊物主题：Medicine & Public Health
  Cardiology
  Cardiac Surgery
  Vascular Surgery
  
• 出版者：Springer New York
• ISSN：1432-1971

文摘

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-49 (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 (175-22?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.