Chandhar Poorna, Pramanik Subrata, Gupta Anubhav, Gupta Manju
Department of Cardiac/Thoracic/Vascular Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND.
Cureus. 2024 Jun 25;16(6):e63133. doi: 10.7759/cureus.63133. eCollection 2024 Jun.
Background Although the recommended time for total correction of tetralogy of Fallot (TOF) is during infancy, sometimes TOF cases present to healthcare setups after pre-school age, with some cases presenting even beyond adolescence in developing countries. The objective of this study was to assess patients with TOF weighing 10 kg and above who underwent definitive corrective surgical techniques such as transannular patch (TAP), valve-sparing right ventricular outflow tract (RVOT) pericardial patch augmentation, non-ventriculotomy infundibular resection for postoperative complications, hospital stay, and right ventricular (RV) dysfunction in the immediate postoperative period and subsequent outpatient department follow-ups. Methodology This comprehensive, retrospective cohort study included single-center data collected between January 16, 2018, and January 15, 2024. The study included 63 patients diagnosed with TOF weighing 10 kg and above, ensuring a robust and representative sample. Results Of the 119 patients who underwent total correction for TOF, 63 met the study's inclusion criteria of TOF weighing above 10 kg. Of the 63 patients, 55.6% were males, and 44.4% were females. The mean weight of the study participants was 33.4 kg. The mean age was 15.9 years. Of the 63 patients, 39 underwent TAP surgery, 18 underwent RVOT patch augmentation, and six underwent total correction by non-ventriculotomy infundibular resection. There was a significant difference between the type of surgery groups and RV dysfunction, with the TAP group showing a higher incidence of RV dysfunction, indicating a potential risk factor associated with this technique. Conclusions Although TAP has significant immediate postoperative complications compared to other techniques, its long-term follow-up suggests that long-term survival and quality of life, as measured by major adverse cardiac events such as heart failure, arrhythmias, and reoperation rates, are commensurable in adulthood. This indicates that despite the initial challenges, TAP can provide satisfactory outcomes in the long run.
尽管法洛四联症（TOF）完全矫正的推荐时间是在婴儿期，但在发展中国家，有时TOF病例在学龄前才被送至医疗机构，有些病例甚至在青春期后才出现。本研究的目的是评估体重10公斤及以上的TOF患者，这些患者接受了确定性矫正手术技术，如跨环补片（TAP）、保留瓣膜的右心室流出道（RVOT）心包补片扩大术、非心室切开漏斗部切除术，以评估术后并发症、住院时间以及术后即刻和随后门诊随访中的右心室（RV）功能障碍。
这项全面的回顾性队列研究纳入了2018年1月16日至2024年1月15日期间收集的单中心数据。该研究纳入了63例诊断为TOF且体重10公斤及以上的患者，确保了样本的充分性和代表性。
在119例接受TOF完全矫正的患者中，63例符合该研究中体重超过10公斤的TOF纳入标准。在这63例患者中，55.6%为男性，44.4%为女性。研究参与者的平均体重为33.4公斤。平均年龄为15.9岁。在63例患者中，39例接受了TAP手术，18例接受了RVOT补片扩大术，6例通过非心室切开漏斗部切除术进行了完全矫正。手术类型组与RV功能障碍之间存在显著差异，TAP组的RV功能障碍发生率较高，表明该技术存在潜在风险因素。
尽管与其他技术相比，TAP术后即刻并发症较多，但其长期随访表明，从心力衰竭、心律失常和再次手术率等主要不良心脏事件衡量的长期生存率和生活质量在成年期是相当的。这表明，尽管初期存在挑战，但从长远来看，TAP可以提供令人满意的结果。
