Finkelstein Amit, Sion-Sarid Rachel, Zipper Oren, Mitler Avital, Erell Yair
School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel.
Pediatric Intensive Care Department, Wolfson Medical Center, Holon, Israel.
Pediatr Cardiol. 2025 Jan 30. doi: 10.1007/s00246-025-03786-9.
Research establishing factors associated with duration of mechanical ventilation after Tetralogy of Fallot repair, is mainly based on population presenting at early infancy. There are fewer reports regarding repair after infancy, during childhood and preadolescence. To compare two groups of late TOF repair based on post-operative invasive mechanical ventilation duration and explore associations with pre-operative clinical markers of severity of right ventricular outflow tract obstruction. A single-center retrospective cohort study based on medical charts review of patients older than 12 months who underwent primary complete TOF repair between 2017 and 2023. Patients younger than 12 months or those who had distinct anatomical variants were excluded. Pre-operative characteristics reflecting the severity of right ventricular outflow tract obstruction were collected, including baseline oxygen saturation, the occurrence of hypercyanotic spells, maximum right ventricular outflow tract pressure gradient. Perioperative variables included repair type, cardiopulmonary bypass and aortic cross-clamp duration, and rates of residual lesions. 280 patients from 27 countries were screened; 181 remained eligible and were significantly older than previously reported. 129 (71%) were extubated early post-operatively, while 52 (29%) had a longer ventilation course. In a multivariate analysis, only baseline oxygen saturation and repair type maintained a significant association with length of mechanical ventilation. In distinctly older patients undergoing TOF repair, those with lower base line saturation undergoing a non-valve preserving repair are more likely to have a longer course of mechanical ventilation. Other clinical markers reflecting the severity of right ventricular outflow tract obstruction were not independently associated with mechanical ventilation duration.
关于法洛四联症修复术后机械通气持续时间相关因素的研究，主要基于婴儿早期的人群。关于婴儿期后、儿童期和青春期前修复的报道较少。比较两组晚期法洛四联症修复术患者的术后有创机械通气持续时间，并探讨与术前右心室流出道梗阻严重程度临床指标的相关性。一项单中心回顾性队列研究，基于对2017年至2023年间接受初次完全性法洛四联症修复术的12个月以上患者的病历审查。排除12个月以下的患者或有明显解剖变异的患者。收集反映右心室流出道梗阻严重程度的术前特征，包括基线血氧饱和度、缺氧发作的发生情况、右心室流出道最大压力梯度。围手术期变量包括修复类型、体外循环和主动脉阻断时间以及残余病变发生率。对来自27个国家的280例患者进行了筛查；181例符合条件，且年龄明显大于先前报道。129例（71%）术后早期拔管，而52例（29%）通气时间较长。在多变量分析中，只有基线血氧饱和度和修复类型与机械通气时间保持显著相关性。在年龄明显较大的法洛四联症修复术患者中，基线饱和度较低且接受非保留瓣膜修复的患者更有可能有较长的机械通气时间。其他反映右心室流出道梗阻严重程度的临床指标与机械通气持续时间无独立相关性。
