Primary surgical repair of tetralogy of Fallot at under three months of age.
Primary surgical repair of tetralogy of Fallot at under three months of age.
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DOI：
10.1177/0218492318803037
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发表时间：
2018-09-01
影响因子：
0.7
通讯作者：
Viola, Nicola
中科院分区：
文献类型：
--
作者：
Ho, Andrew B;Bharucha, Tara;Viola, Nicola
背景 对法洛四联症小婴儿的经典治疗涉及放置 Blalock-Taussig 分流器，然后进行完全修复，而不是较大婴儿采用的初次完全修复策略。与分阶段策略相比，早期完整修复的一些优势已经显现。我们试图审查我们的机构成果。方法回顾性分析2005年至2015年在我院接受法洛四联症完全手术修复的3月龄以下患者，并与经解剖诊断和流出道干预相匹配的年龄较大对照组进行比较。结果 确定了 14 例指示病例（A 组）和 14 例对照病例（B 组）。手术时，A 组的中位年龄为 43 天，体重为 4.2 kg，B 组为 130 天，体重为 6.1 kg。A 组 14 名患者中，有 9 名因急诊入院接受手术，而 B 组则没有。A 组的正性肌力峰值评分（22.3 vs. 12.8，p=0.02）和重症监护病房住院时间（4.4 vs. 2.6 天，p=0.02）较高。旁路和交叉钳位时间、持续时间 插管和总住院时间没有差异。结论 我们的结论是，尽管接受法洛四联症早期修复术的婴儿在术后早期对重症监护支持的需求有所增加，但尽管急诊入院次数增多，但总住院时间并未延长。众所周知，早期修复可以降低长期发病率，我们建议考虑早期完全修复法洛四联症。
Background Classical management of small infants with tetralogy of Fallot has involved placement of a Blalock-Taussig shunt followed later by complete repair, rather than primary complete repair which is the strategy adopted in larger infants. Some advantages of early complete repair compared to a staged strategy have been shown. We sought to review our institutional outcomes. Methods Patients under 3-months old undergoing complete surgical repair of tetralogy of Fallot in our institution between 2005 and 2015 were retrospectively reviewed and compared with an older control group matched by anatomical diagnosis and outflow tract intervention. Results Fourteen index cases (group A) and 14 controls (group B) were identified. At surgery, the median age was 43 days and weight 4.2 kg in group A, and 130 days and 6.1 kg in group B. Nine of 14 in group A were admitted for surgery as emergencies compared to none in group B. Peak inotrope score (22.3 vs. 12.8, p=0.02) and intensive care unit stay (4.4 vs. 2.6 days, p=0.02) were higher in group A. Bypass and crossclamp times, duration of intubation, and total length of stay did not differ. Conclusions We conclude that although babies undergoing early repair of tetralogy of Fallot have an increased need for intensive care support in the early postoperative period, the total length of stay is not prolonged despite more emergency admissions. As it is known that early repair may reduce long-term morbidity, we propose consideration of earlier complete repair of tetralogy of Fallot.