Perioperative outcome following late correction of tetralogy of Fallot in a humanitarian project

Details

Ressource 1Download: Mémoire no 4529 Mme Guarino.pdf (20006.07 [Ko])
State: Public
Version: After imprimatur
License: Not specified
Serval ID
serval:BIB_25376BC93CAF
Type
A Master's thesis.
Publication sub-type
Master (thesis) (master)
Collection
Publications
Institution
Title
Perioperative outcome following late correction of tetralogy of Fallot in a humanitarian project
Author(s)
GUARINO L.
Director(s)
KADNER A.
Codirector(s)
HUTTER D.
Institution details
Université de Lausanne, Faculté de biologie et médecine
Publication state
Accepted
Issued date
2017
Language
english
Number of pages
17
Abstract
Objective: To report our experience and results of late surgical correction of patients with
tetralogy of Fallot (TOF) in the context of a humanitarian collaboration program.
Material & Patients: Retrospective analysis of the perioperative course of all patients
undergoing correction of TOF after x years of age at the University Hospital Bern or the
University Children’s Hospital Rabat between November 2011 to November 2016.
Results: 25 children (mean age: 70.8 months, range: 23-163; 44% female) underwent total
correction of TOF. Two patients were initially palliated with a shunt with subsequent
correction after 108 and 24 months. Preoperative oxygen saturation was 84±12%; mean
hemoglobin was 147±31g/l. Preoperative mean RV/PA gradient was 84±32mmHg with a
Nakata index of 163.6±70.5mm2/m2. Large aorto-pulmonary collateral vessels (MAPCAs)
were observed in n=8 (32%), and n=6 (26%) underwent transcatheter closure just before
surgical correction. Presence of coronary abnormality in 28% of the cases (n=7). 96 %
underwent a valve-sparing correction. Early mortality was 0%; perioperative morbidities were
0%, stroke 0%, postoperative pacing 0% and no patient required an extracorporeal
membrane oxygenation. Mean duration of mechanical ventilation was 28.7±19.6h (range: 7-
76).
Last follow-up was 1 month due to the setting of program. Last echocardiography
demonstrated a mean RV/PA gradient of 34.6±14.8mmHg; LVEF >60% in all cases, with no
RV dysfunction. Postoperative saturation was 98% (range: 95-100%). A residual pulmonary
stenosis was light in n=7, moderate in n=10 patients. Concerning the residual subvalvular
pulmonary stenosis: moderate in n= 3. Finally, the supravalvular pulmonary stenosis was
light in n= 1, moderate in n=6 without any severe PV insufficiency. 1 patient underwent
reoperation for patch dehiscence, 1 patient underwent reoperation for recurrent pulmonary
stenosis. Length of stay was 11.7±4.5 days (4.8±2.4 days in ICU).
For 11 children, we have a 6-month follow-up exam which showed good results without any
need of reoperation or reintervention.
Conclusions: Late correction of TOF can be safely performed in older children with good
early postoperative results and low morbidity comparable to reported results for “timely”
correction in infants. A valve-sparing correction might be possible in majority of those
patients. Follow-up study for the evaluation of the development of right ventricular and
pulmonary valve dysfunction is needed and under way…
Create date
06/09/2018 9:49
Last modification date
08/09/2020 6:08
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