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Long-term Outcomes of Tetralogy of Fallot in the Kingdom of Bahrain
INTRODUCTION: Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease. Surgical correction has improved survival but re-intervention is often required. OBJECTIVES: The objective is to assess outcomes after surgical repair of TOF, long-term follow-up, and factors that influence...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Wolters Kluwer - Medknow
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9542972/ https://www.ncbi.nlm.nih.gov/pubmed/36213434 http://dx.doi.org/10.4103/heartviews.heartviews_77_21 |
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author | Agarwal, Abhinav Al Amer, Suad R. Al Tarif, Habib Ismael, Aieshah Ahmed Alshaiji, Abdulla Faisal Arulselvam, Vimalarani Kalis, Neale Nicola |
author_facet | Agarwal, Abhinav Al Amer, Suad R. Al Tarif, Habib Ismael, Aieshah Ahmed Alshaiji, Abdulla Faisal Arulselvam, Vimalarani Kalis, Neale Nicola |
author_sort | Agarwal, Abhinav |
collection | PubMed |
description | INTRODUCTION: Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease. Surgical correction has improved survival but re-intervention is often required. OBJECTIVES: The objective is to assess outcomes after surgical repair of TOF, long-term follow-up, and factors that influence these results. MATERIALS AND METHODS: This is a retrospective study conducted in a tertiary care center. Records of patients diagnosed with TOF from 1992 to 2019 (37 years) were retrieved from a detailed database. Patients who underwent complete correction were grouped according to diagnosis, the technique utilized in surgical repair, need for staged repair, and syndromic association. Univariate actuarial and event-free survival analysis was performed. The endpoint for an event was death or re-intervention. RESULTS: A total of 230 patients were diagnosed with TOF and 174 patients underwent complete surgical repair. At 40 years postoperatively, survival was 96%. Actuarial survival was independent of syndromic associations, anatomical diagnosis, type of surgery, or previous shunt. Event-free survival (EFS) survival was 8.12%. EFS was significantly worse for patients with pulmonary atresia (PA) (Hazard ratio, 4.1125; 95% confidence interval [CI], 1.2654–13.3657; P < 0.0001) and for those that required homograft/conduit. The median duration for EFS was 22.73 years, 19.58 years, and 9.12 years for transannular patch (TAP), pulmonary valve-sparing (PVS), and homograft group, respectively. The survival curve for the PVS group merged with that of TAP 20 years postoperatively. Similarly, it merged at 22 years for staged versus primary repair and at 22.73 years for syndromic versus nonsyndromic patients. A weak correlation was found between age at surgery and event-free duration (cc, 0.309; P < 0.0001). The need for TAP was not influenced by the previous palliation, χ(2)(1, n = 154) = 3.36, P = 0.0667, or with interval to complete correction after the shunt procedure (P = 0.9672). CONCLUSIONS: Total correction of TOF has low perioperative mortality and good long-term survival, but the need for re-interventions is high. This study demonstrated that patients requiring homograft/conduit and those with a diagnosis of PA had worse outcomes. Comparison between different surgical groups showed merging of survival curves in follow-up that signifies gradual loss of survival advantage over time. |
format | Online Article Text |
id | pubmed-9542972 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Wolters Kluwer - Medknow |
record_format | MEDLINE/PubMed |
spelling | pubmed-95429722022-10-08 Long-term Outcomes of Tetralogy of Fallot in the Kingdom of Bahrain Agarwal, Abhinav Al Amer, Suad R. Al Tarif, Habib Ismael, Aieshah Ahmed Alshaiji, Abdulla Faisal Arulselvam, Vimalarani Kalis, Neale Nicola Heart Views Original Article INTRODUCTION: Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease. Surgical correction has improved survival but re-intervention is often required. OBJECTIVES: The objective is to assess outcomes after surgical repair of TOF, long-term follow-up, and factors that influence these results. MATERIALS AND METHODS: This is a retrospective study conducted in a tertiary care center. Records of patients diagnosed with TOF from 1992 to 2019 (37 years) were retrieved from a detailed database. Patients who underwent complete correction were grouped according to diagnosis, the technique utilized in surgical repair, need for staged repair, and syndromic association. Univariate actuarial and event-free survival analysis was performed. The endpoint for an event was death or re-intervention. RESULTS: A total of 230 patients were diagnosed with TOF and 174 patients underwent complete surgical repair. At 40 years postoperatively, survival was 96%. Actuarial survival was independent of syndromic associations, anatomical diagnosis, type of surgery, or previous shunt. Event-free survival (EFS) survival was 8.12%. EFS was significantly worse for patients with pulmonary atresia (PA) (Hazard ratio, 4.1125; 95% confidence interval [CI], 1.2654–13.3657; P < 0.0001) and for those that required homograft/conduit. The median duration for EFS was 22.73 years, 19.58 years, and 9.12 years for transannular patch (TAP), pulmonary valve-sparing (PVS), and homograft group, respectively. The survival curve for the PVS group merged with that of TAP 20 years postoperatively. Similarly, it merged at 22 years for staged versus primary repair and at 22.73 years for syndromic versus nonsyndromic patients. A weak correlation was found between age at surgery and event-free duration (cc, 0.309; P < 0.0001). The need for TAP was not influenced by the previous palliation, χ(2)(1, n = 154) = 3.36, P = 0.0667, or with interval to complete correction after the shunt procedure (P = 0.9672). CONCLUSIONS: Total correction of TOF has low perioperative mortality and good long-term survival, but the need for re-interventions is high. This study demonstrated that patients requiring homograft/conduit and those with a diagnosis of PA had worse outcomes. Comparison between different surgical groups showed merging of survival curves in follow-up that signifies gradual loss of survival advantage over time. Wolters Kluwer - Medknow 2022 2022-07-23 /pmc/articles/PMC9542972/ /pubmed/36213434 http://dx.doi.org/10.4103/heartviews.heartviews_77_21 Text en Copyright: © 2022 Heart Views https://creativecommons.org/licenses/by-nc-sa/4.0/This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms. |
spellingShingle | Original Article Agarwal, Abhinav Al Amer, Suad R. Al Tarif, Habib Ismael, Aieshah Ahmed Alshaiji, Abdulla Faisal Arulselvam, Vimalarani Kalis, Neale Nicola Long-term Outcomes of Tetralogy of Fallot in the Kingdom of Bahrain |
title | Long-term Outcomes of Tetralogy of Fallot in the Kingdom of Bahrain |
title_full | Long-term Outcomes of Tetralogy of Fallot in the Kingdom of Bahrain |
title_fullStr | Long-term Outcomes of Tetralogy of Fallot in the Kingdom of Bahrain |
title_full_unstemmed | Long-term Outcomes of Tetralogy of Fallot in the Kingdom of Bahrain |
title_short | Long-term Outcomes of Tetralogy of Fallot in the Kingdom of Bahrain |
title_sort | long-term outcomes of tetralogy of fallot in the kingdom of bahrain |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9542972/ https://www.ncbi.nlm.nih.gov/pubmed/36213434 http://dx.doi.org/10.4103/heartviews.heartviews_77_21 |
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