Young infants with symptomatic tetralogy of Fallot: Shunt or primary repair?Central MessagePerspective
Xin Tao Ye, MD,
Soichiro Henmi, MD, PhD,
Edward Buratto, MBBS, PhD,
Mitchell C. Haverty, MS,
Can Yerebakan, MD,
Tyson Fricke, MBBS, PhD,
Christian P. Brizard, MD, MS,
Yves d’Udekem, MD, PhD,
Igor E. Konstantinov, MD, PhD
Affiliations
Xin Tao Ye, MD
Department of Cardiac Surgery, Royal Children’s Hospital, Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia; Heart Research Group, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
Soichiro Henmi, MD, PhD
Division of Cardiac Surgery, Children's National Hospital, Washington, DC
Edward Buratto, MBBS, PhD
Department of Cardiac Surgery, Royal Children’s Hospital, Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia; Heart Research Group, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
Mitchell C. Haverty, MS
Division of Cardiac Surgery, Children's National Hospital, Washington, DC
Can Yerebakan, MD
Division of Cardiac Surgery, Children's National Hospital, Washington, DC; The George Washington University School of Medicine and Health Sciences, Washington, DC
Tyson Fricke, MBBS, PhD
Department of Cardiac Surgery, Royal Children’s Hospital, Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia; Heart Research Group, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
Christian P. Brizard, MD, MS
Department of Cardiac Surgery, Royal Children’s Hospital, Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia; Heart Research Group, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia; The Melbourne Centre for Cardiovascular Genomics and Regenerative Medicine, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
Yves d’Udekem, MD, PhD
Division of Cardiac Surgery, Children's National Hospital, Washington, DC; The George Washington University School of Medicine and Health Sciences, Washington, DC
Igor E. Konstantinov, MD, PhD
Department of Cardiac Surgery, Royal Children’s Hospital, Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia; Heart Research Group, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia; The Melbourne Centre for Cardiovascular Genomics and Regenerative Medicine, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia; Address for reprints: Igor E. Konstantinov, MD, PhD, Cardiac Surgery Unit, Royal Children’s Hospital, Flemington Rd, Parkville, Victoria 3029, Australia.
Objectives: The optimal treatment strategy for symptomatic young infants with tetralogy of Fallot (TOF) is unclear. We sought to compare the outcomes of staged repair (SR) (shunt palliation followed by second-stage complete repair) versus primary repair (PR) at 2 institutions that have exclusively adopted each strategy. Methods: We performed propensity score-matched comparison of 143 infants under 4 months of age who underwent shunt palliation at one institution between 1993 and 2021 with 122 infants who underwent PR between 2004 and 2018 at another institution. The primary outcome was mortality. Secondary outcomes were postoperative complications, durations of perioperative support and hospital stays, and reinterventions. Median follow-up was 8.3 years (interquartile range, 8.1-13.4 years). Results: After the initial procedure, hospital mortality (shunt, 2.8% vs PR, 2.5%; P = .86) and 10-year survival (shunt, 95%; 95% confidence interval [CI], 90%-98% vs PR, 90%; 95% CI, 81%-95%; P = .65) were similar. The SR group had a greater risk of early reinterventions but similar rates of late reinterventions. Propensity score matching yielded 57 well-balanced pairs. In the matched cohort, the SR group had similar freedom from reintervention (55%; 95% CI, 39%-68% vs 59%; 95% CI, 43%-71%; P = .85) and greater survival (98%; 95% CI, 88%-99.8% vs 85%; 95% CI, 69%-93%; P = .02) at 10 years, as the result of more noncardiac-related mortalities in the PR group. Conclusions: In symptomatic young infants with TOF operated at 2 institutions with exclusive treatment protocols, the SR strategy was associated with similar cardiac-related mortality and reinterventions as the PR strategy at medium-term follow-up.
