Bashir Mohamed Nabih, Elkasaby Mohamed Hamouda, Belal Mohamed Mohamed, Saad Loubna Mohamed, Khalefa Basma Badrawy, Yassin Mazen Negmeldin Aly, El-Hameed Malak Mohamed Abd, Almawas Safaa Mohammad, El-Gayar Rawan Medhat
Faculty of Medicine, Alexandria University, Alexandria, Egypt.
Medical Research Group of Egypt (MRGE), Negida Academy, Arlington, MA, USA.
Pediatr Cardiol. 2025 Jul 14. doi: 10.1007/s00246-025-03949-8.
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.
治疗有症状的法洛四联症（TOF）新生儿有两种策略，即一期修复（PR）和分期修复（SR）。关于最佳手术策略仍存在争议。我们旨在比较PR和SR在死亡率和合并症方面的差异。我们在PubMed、Embase、Scopus、科学网（WOS）和考科蓝中心进行了系统检索，直至2025年1月10日。我们纳入了有症状TOF新生儿在出生后30天内接受SR或PR干预的研究。主要结局是住院死亡率、30天死亡率和2年死亡率。我们使用Review Manager计算分类变量的风险比（RR）及其95%置信区间（CI），以及连续结局的平均差（MD）及其95%CI。P值小于0.05被认为具有统计学意义。I²检验用于评估异质性。两种方法在30天和2年时的死亡率RR具有可比性，分别为（RR = 0.53；[95%CI = 0.22 - 1.27]，P = 0.15）和（RR = 1.22；[95%CI = 0.99 - 1.51]，P = 0.07）。而住院时间（MD = 18.47天；[95%CI = 10.87 - 26.08]，P < 0.00001）、重症监护病房住院时间（MD = 4.18天；[95%CI = 3.12 - 5.23]，P < 0.00001）和体外循环时间（MD = 46.47天；[95%CI = 37.71 - 55.24]，P < 0.00001），SR组均更长。对于有症状TOF的新生儿，PR和SR策略在短期和长期死亡率方面相当。
