TY - JOUR
T1 - Comparison of treatment strategies for neonates with tetralogy of Fallot and pulmonary atresia
AU - Meadows, Jeffery J.
AU - Bauser-Heaton, Holly
AU - Petit, Christopher J.
AU - Goldstein, Bryan H.
AU - Qureshi, Athar M.
AU - McCracken, Courtney E.
AU - Kelleman, Michael S.
AU - Nicholson, George T.
AU - Law, Mark A.
AU - Zampi, Jeffrey D.
AU - Shahanavaz, Shabana
AU - Chai, Paul J.
AU - Romano, Jennifer C.
AU - Batlivala, Sarosh P.
AU - Maskatia, Shiraz A.
AU - Asztalos, Ivor B.
AU - Eilers, Lindsay
AU - Kamsheh, Alicia M.
AU - Healan, Steven J.
AU - Smith, Justin D.
AU - Ligon, R. Allen
AU - Dailey-Schwartz, Andrew
AU - Pettus, Joelle A.
AU - Pajk, Amy L.
AU - Glatz, Andrew C.
AU - Mascio, Christopher E.
N1 - Publisher Copyright:
© 2023 The American Association for Thoracic Surgery
PY - 2023/9
Y1 - 2023/9
N2 - Objective: Neonates with tetralogy of Fallot and pulmonary atresia (TOF/PA) but no major aorta-pulmonary collaterals are dependent on the arterial duct for pulmonary blood flow and require early intervention, either by primary (PR) or staged repair (SR) with initial palliation (IP) followed by complete repair (CR). The optimal approach has not been established. Methods: Neonates with TOF/PA who underwent PR or SR were retrospectively reviewed from the Congenital Cardiac Research Collaborative. Outcomes were compared between PR and SR (IP + CR) strategies. Propensity scoring was used to adjust for baseline differences. The primary outcome was mortality. Secondary outcomes included complications, length of stay, cardiopulmonary bypass and anesthesia times, reintervention (RI), and pulmonary artery (PA) growth. Results: Of 282 neonates, 106 underwent PR and 176 underwent SR (IP: 144 surgical, 32 transcatheter). Patients who underwent SR were more likely to have DiGeorge syndrome and greater rates of mechanical ventilation before the initial intervention. Mortality was not significantly different. Duration of mechanical ventilation, inotrope use, and complication rates were similar. Cumulative length of stay, cardiopulmonary bypass, and anesthesia times favored PR (P ≤.001). Early RI was more common in patients who underwent SR (rate ratio, 1.42; P =.003) but was similar after CR (P =.837). Conduit size at the time of CR was larger with SR. Right PA growth was greater with PR. Conclusions: In neonates with TOF/PA, SR is more common in greater-risk patients. Accounting for this, SR and PR strategies have similar mortality. Perioperative morbidities, RI, and right PA growth generally favor PR, whereas SR allows for larger initial conduit implantation.
AB - Objective: Neonates with tetralogy of Fallot and pulmonary atresia (TOF/PA) but no major aorta-pulmonary collaterals are dependent on the arterial duct for pulmonary blood flow and require early intervention, either by primary (PR) or staged repair (SR) with initial palliation (IP) followed by complete repair (CR). The optimal approach has not been established. Methods: Neonates with TOF/PA who underwent PR or SR were retrospectively reviewed from the Congenital Cardiac Research Collaborative. Outcomes were compared between PR and SR (IP + CR) strategies. Propensity scoring was used to adjust for baseline differences. The primary outcome was mortality. Secondary outcomes included complications, length of stay, cardiopulmonary bypass and anesthesia times, reintervention (RI), and pulmonary artery (PA) growth. Results: Of 282 neonates, 106 underwent PR and 176 underwent SR (IP: 144 surgical, 32 transcatheter). Patients who underwent SR were more likely to have DiGeorge syndrome and greater rates of mechanical ventilation before the initial intervention. Mortality was not significantly different. Duration of mechanical ventilation, inotrope use, and complication rates were similar. Cumulative length of stay, cardiopulmonary bypass, and anesthesia times favored PR (P ≤.001). Early RI was more common in patients who underwent SR (rate ratio, 1.42; P =.003) but was similar after CR (P =.837). Conduit size at the time of CR was larger with SR. Right PA growth was greater with PR. Conclusions: In neonates with TOF/PA, SR is more common in greater-risk patients. Accounting for this, SR and PR strategies have similar mortality. Perioperative morbidities, RI, and right PA growth generally favor PR, whereas SR allows for larger initial conduit implantation.
KW - congenital heart disease
KW - pulmonary atresia
KW - staged repair
KW - tetralogy of Fallot
UR - http://www.scopus.com/inward/record.url?scp=85148867946&partnerID=8YFLogxK
U2 - 10.1016/j.jtcvs.2023.01.008
DO - 10.1016/j.jtcvs.2023.01.008
M3 - Article
C2 - 36828672
AN - SCOPUS:85148867946
SN - 0022-5223
VL - 166
SP - 916-925.e6
JO - Journal of Thoracic and Cardiovascular Surgery
JF - Journal of Thoracic and Cardiovascular Surgery
IS - 3
ER -