Outcomes of Primary Vs. Staged Repair in 4628 Neonates with Symptomatic Tetralogy of Fallot: A Systematic Review and Meta-analysis.

There are two strategies to treat neonates with symptomatic tetralogy of Fallot (TOF), primary repair (PR) and staged repair (SR). There is still a debate on the best surgical strategy. We aim to compare PR and SR regarding mortality and comorbidities. We executed a systematic search on PubMed, Embase, Scopus, Web of Science (WOS), and Cochrane Central till January 10, 2025. We included studies with neonates with symptomatic TOF who received an intervention within the first 30 days of life, either with SR or PR. The primary outcomes were in-hospital, 30-day, and 2-year mortality rates. We used Review Manager to calculate the risk ratio (RR) and its 95% confidence interval (CI) for categorical variables and the mean difference (MD) and its 95% CI for continuous outcomes. A P-value less than 0.05 was considered significant. The I-squared test was used to assess heterogeneity. The RRs of mortality at 30 days and 2 years were comparable between both approaches (RR = 0.53; [95% CI = 0.22-1.27], P = 0.15) and (RR = 1.22; [95% CI = 0.0.99-1.51], P = 0.07) respectively. While the length of hospital stay (MD = 18.47 days; [95% CI = 10.87-26.08], P < 0.00001), length of intensive care unit stay (MD = 4.18 days; [95% CI = 3.12-5.23], P < 0.00001), and cardiopulmonary bypass time (MD = 46,47 day; [95% CI = 37.71-55.24], P < 0.00001), all were longer with SR. PR and SR strategies are equivalent regarding short- and long-term mortality in neonates with symptomatic TOF.