Early postoperative complications in patients with Tetralogy of Fallot

Abstract

Introduction. Tetralogy of Fallot (TF) is the most common cyanotic congenital heart malformation, with a wide variety of morphological forms. Depending on the morphological form, the clinical manifestations and the hemodynamic condition of the patient, it is decided the surgical treatment type: staged or radical correction first and the type of radical correction. Aim of study. Different surgical approaches for radical correction have been used to release RVOT obstruction and spare the pulmonary valve (PV) function: application of transannular patch, enlargement of the RVOT with preservation of the valve and application of monocusp valve. The aim of the paper is to present the most common early postoperative complications in patients with TF, and to compare their frequency depending on the surgical tactic approached. Methods and materials. List of the most common early postoperative complications in patients with TF found in the recent specialized medical articles. Retrospective analysis of a group of 96 patients, operated in the Cardiac Surgery clinic of SCR „T. Mosneaga”, from 2015 to 2020. They were separated into subgroups depending on the surgical tactics approached: staged (group A) - 37 patients, radical correction first (group B) - 35 patients. According to the type of radical correction: application of transannular patch – group I - 48 patients, preservation of the valve – group II - 25 patients, application of monocusp valve - group III - 5 patients. The data were analyzed to highlight the most common early postoperative complications in each subgroup, time spent in ICU, lethality rate. Exclusion criteria from the study - patients who underwent only the installation of anastomosis without subsequent radical correction (N = 24). Results. During articles review, the following most common early postoperative complications were found and included in this study: pleural effusion, arrhythmias, pericarditis, ascites, MODS, septic complications, hemorrhages. The remaining RVOT gradients and postoperative pulmonary valve regurgitation were also recorded. Following the analysis of the research data, a higher prevalence of early postoperative complications was determined in the group of patients who underwent radical correction with transannular patch application compared to groups II and III. No significant differences were determined between groups II and III. Duration of stay in ICU was longer in group I - average of 9 days, compared to groups II and III - average duration 6 days. The lethality is also higher in group I - 8 patients (16.6%) vs 2 patients (6%) in groups II and III. When comparing the transvalvular gradients at the level of the pulmonary artery, a higher gradient (average 18.4 mm Hg) was determined in group II vs average gradients of 11.2 mm Hg and 13.2 mm Hg in groups I and III, while higher degree of regurgitation was observed in group I vs. groups II and III. Conclusion. Radical correction of Tetralogy of Fallot shows good early results, with a survival rate of 92%, compared to 68% at the beginning of the development of surgical correction tactics. Patients who have undergone radical correction with preservation of the pulmonary artery valve have excellent results with minimal residual regurgitation, compared to those who undergo transannular radical correction. The application of synthetic monocusp valves shows good early results, but requires long-term evaluation to assess its subsequent functionality.