Management of tetralogy of fallot in developing countries: opportunities and challenges for surgeons

This study evaluates outcomes of Tetralogy of Fallot (TOF) correction, focusing on survival, complications, and management insights in a developing country setting. This cohort retrospective study analyzed medical records of patients with TOF undergoing total correction (April 2024–April 2025). Variables included demographics, McGoon ratio, Cardiopulmonary Bypass (CPB), Aortic Cross Clamp (AOX), Length of Stay (LOS), morbidity, and mortality. Data were analyzed with chi-square and Mann-Whitney tests ( p < 0.05). Among 43 patients with TOF undergoing late total correction, mortality was 11.6%, higher than reported rates in low- and middle-income countries. Most cases presented late (mean age 9.19 years), underweight (65.1%), and hypoxemic (SpO₂ <90% in 79.1%). Predominant subvalvar stenosis led to prolonged CPB and AOX times. Deaths occurred only in children < 2 years. Limited Intensive Care Unit resources and delayed referral likely worsened outcomes, underscoring the need for early surgery, nutrition support, and infection control. Delayed referral and limited early detection within the community should not preclude surgical correction in patients older than one year. With appropriate perioperative management, favorable outcomes remain achievable despite late presentation. Enhancing preoperative optimization, perioperative management, and postoperative care could improve late-repair outcomes and align results with global standards.