Perioperative outcome following late correction of tetralogy of Fallot in a humanitarian project

Objective: To report our experience and results of late surgical correction of patients with tetralogy of Fallot (TOF) in the context of a humanitarian collaboration program. Material & Patients: Retrospective analysis of the perioperative course of all patients undergoing correction of TOF after x years of age at the University Hospital Bern or the University Children’s Hospital Rabat between November 2011 to November 2016. Results: 25 children (mean age: 70.8 months, range: 23-163; 44% female) underwent total correction of TOF. Two patients were initially palliated with a shunt with subsequent correction after 108 and 24 months. Preoperative oxygen saturation was 84±12%; mean hemoglobin was 147±31g/l. Preoperative mean RV/PA gradient was 84±32mmHg with a Nakata index of 163.6±70.5mm2/m2. Large aorto-pulmonary collateral vessels (MAPCAs) were observed in n=8 (32%), and n=6 (26%) underwent transcatheter closure just before surgical correction. Presence of coronary abnormality in 28% of the cases (n=7). 96 % underwent a valve-sparing correction. Early mortality was 0%; perioperative morbidities were 0%, stroke 0%, postoperative pacing 0% and no patient required an extracorporeal membrane oxygenation. Mean duration of mechanical ventilation was 28.7±19.6h (range: 7- 76). Last follow-up was 1 month due to the setting of program. Last echocardiography demonstrated a mean RV/PA gradient of 34.6±14.8mmHg; LVEF >60% in all cases, with no RV dysfunction. Postoperative saturation was 98% (range: 95-100%). A residual pulmonary stenosis was light in n=7, moderate in n=10 patients. Concerning the residual subvalvular pulmonary stenosis: moderate in n= 3. Finally, the supravalvular pulmonary stenosis was light in n= 1, moderate in n=6 without any severe PV insufficiency. 1 patient underwent reoperation for patch dehiscence, 1 patient underwent reoperation for recurrent pulmonary stenosis. Length of stay was 11.7±4.5 days (4.8±2.4 days in ICU). For 11 children, we have a 6-month follow-up exam which showed good results without any need of reoperation or reintervention. Conclusions: Late correction of TOF can be safely performed in older children with good early postoperative results and low morbidity comparable to reported results for “timely” correction in infants. A valve-sparing correction might be possible in majority of those patients. Follow-up study for the evaluation of the development of right ventricular and pulmonary valve dysfunction is needed and under way…