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Comparison of management strategies for neonates with symptomatic tetralogy of Fallot and weight2.5 kg
- Source :
- The Journal of thoracic and cardiovascular surgery. 163(1)
- Publication Year :
- 2020
-
Abstract
- To compare management strategies for neonates2.5 kg with tetralogy of Fallot and symptomatic cyanosis who either undergo staged repair (SR) (initial palliation followed by later complete repair) or primary repair (PR).Consecutive neonates with tetralogy of Fallot and symptomatic cyanosis weighing2.5 kg at initial intervention and between 2005 and 2017 were retrospectively reviewed from the Congenital Cardiac Research Collaborative. Primary outcome was mortality and secondary outcomes included component (eg, initial palliation, complete repair, or primary repair) and cumulative (SR: initial palliation followed by later complete repair) hospital and intensive care unit lengths of stay, durations of ventilation, inotrope use, cardiopulmonary bypass time, procedural complications, and reintervention. Outcomes were compared with propensity score adjustments with PR as the reference group.The cohort included 76 SR (initial palliation: 53 surgical and 23 transcatheter) and 44 PR patients. The observed risk of overall mortality was similar between SR and PR groups (15.8% vs 18.2%: P = .735). The adjusted hazard of mortality remained similar between groups overall (hazard ratio, 0.59; 95% confidence interval, 0.26-1.36; P = .214), as well as during short-term (4 months: hazard ratio, 0.37; 95% confidence interval, 0.13-1.09; P = .071) and midterm (4 months: hazard ratio, 1.32; 95% confidence interval, 0.30-5.79; P = .717) follow-up. Reintervention in the first 18 months was common in both groups (53.2% vs 48.4%; hazard ratio, 1.69; 95% confidence interval, 0.96-2.28; P = .072). Adjusted procedural complications and neonatal morbidity burden were overall lower in the SR group. Cumulative secondary outcome burdens largely favored the PR group.In this study comparing SR and PR treatment strategies for neonates with tetralogy of Fallot and symptomatic cyanosis and weight2.5 kg, mortality and reintervention burden was high and independent of treatment strategy. Other potential advantages were observed with each approach.
- Subjects :
- Pulmonary and Respiratory Medicine
Male
Reoperation
medicine.medical_specialty
Comparative Effectiveness Research
030204 cardiovascular system & hematology
law.invention
03 medical and health sciences
0302 clinical medicine
Secondary outcome
Postoperative Complications
law
Internal medicine
Cardiopulmonary bypass
Medicine
Humans
Cardiac Surgical Procedures
Tetralogy of Fallot
Cyanosis
business.industry
Patient Selection
Hazard ratio
Body Weight
Palliative Care
Infant, Newborn
Infant, Low Birth Weight
medicine.disease
Intensive care unit
Confidence interval
Patient Care Management
Neonatal morbidity
Outcome and Process Assessment, Health Care
030228 respiratory system
Cohort
Cardiology
Surgery
Female
Risk Adjustment
Cardiology and Cardiovascular Medicine
business
Subjects
Details
- ISSN :
- 1097685X
- Volume :
- 163
- Issue :
- 1
- Database :
- OpenAIRE
- Journal :
- The Journal of thoracic and cardiovascular surgery
- Accession number :
- edsair.doi.dedup.....ac4101a9cb73783f62fd9774f245d276