BackgroundOlder patients with severe cyanosis from unrepaired tetralogy of Fallot (TOF) face high perioperative morbidity despite technically straightforward surgical repair. Chronic hypoxemia leads to myocardial metabolic adaptation, polycythemia, and increased susceptibility to reperfusion injury. Preoperative optimization may improve outcomes in this high-risk group.ObjectiveTo evaluate whether palliative balloon pulmonary valvotomy (BPV) before intracardiac repair (ICR) improves immediate postoperative outcomes in severely cyanotic patients with uncomplicated TOF.MethodsA prospective observational study was conducted on 42 patients (age: 5 months-40 years) with severe cyanosis (oxygen saturation P = .011), inotrope duration (46.9 ± 15.5 vs 64.3 ± 30.8 h, P = .001), ICU stay (62.9 ± 36.8 vs 94.9 ± 43.1 h, P P = .001). No mortality occurred in the BPV-ICR group versus two deaths in the control group.ConclusionsPalliative BPV significantly improves preoperative condition and reduces immediate postoperative morbidity in severely cyanotic, anatomically suitable TOF patients. A staged BPV-ICR approach may be a safe, effective strategy in resource-limited settings.
Kasturi et al. (Fri,) studied this question.