Two-stage Correction for Tetralogy of Fallot

Summary

The policy for surgical treatment of tetralogy of Fallot in younger patients is still controversial. Our overall 14-year experience has been reviewed with regard to the factors influencing mortality for both shunts and corrective procedures. An attempt has been made to evaluate our current expected cumulative mortality for two-stage correction in patients under 2 years of age. From November, 1966 through April, 1983, 440 shunts and 647 total corrections were performed. Patients under 2 years of age, and those with unfavorable anatomy and/or physiology, generally underwent two-stage correction. Early correction was occasionally performed in this age group on patients with very favorable anatomy, or in case of early shunt failure. Retrospective standard statistical analysis was carried out in order to evaluate the influences of the year of operation, age, and operative technique on mortality. The overall early mortality of shunt procedures was 5.7 % (11.4 % below and 3.5% over 6 months of age). Since 1978 it has dropped to 2.8 % (4.2 % below and 2.1 % over 6 months). The Waterston shunt had a higher (7%) operative mortality than the Blalock (3%) or Goretex (2.6%) shunts. The overall early mortality of total corrections was 15.1 % (25.2% below and 13.5% over 2 years of age). It has dropped to 6.9% since 1978 (29.9% below and 6.2% over 2 years). The use of a transannular patch was associated with a higher mortality (17% versus 13.5%). Patients with a previously-fitted shunt had a lower mortality (13.8%) than patients with primary correction (16.1 %). In patients under 2 years of age our current expected cumulative mortality for two-stage correction is still lower than the mortality of primary correction. Therefore, we continue to advocate two-stage correction for symptomatic patients under 2 years of age with tetralogy of Fallot.

Key words

Tetralogy of Fallot - Systemic to pulmonary artery shunts - Two-stage corrections