Key result
Transatrial repair of tetralogy of Fallot was associated with a low early mortality rate of 1.67% and a reduction in mean right ventricular outflow tract gradient to 16 mmHg at 23 months follow-up.
Why the study?
The study evaluated early and mid-term outcomes of total correction of tetralogy of Fallot performed via a transatrial approach avoiding ventriculotomy with or without transannular patching.
Does the transatrial approach for total correction of Tetralogy of Fallot result in low morbidity, mortality, and preserved right ventricular function?
Observational (n=180)
No
Does the transatrial approach for total correction of Tetralogy of Fallot result in low morbidity, mortality, and preserved right ventricular function?
The transatrial approach for total correction of Tetralogy of Fallot is associated with low early mortality and morbidity, effectively preserving right ventricular function and avoiding severe pulmonary regurgitation at mid-term follow-up.
Supports transatrial TOF repair in experienced centers; leaves open randomized comparison for long-term RV outcomes.
Background: The objective of this study was to evaluate the early and mid-term outcome of total correction of tetralogy of Fallot (TOF) done through transatrial approach avoiding ventriculotomy with or without transannular patching.Methods: Of 210 patients undergoing total correction for TOF between January 2016 and January 2019, 180 patients were operated via transatrial approach. The ventricular septal defect closure, infundibular resection and pulmonary valvotomy were performed through the right atrium. Age ranged from 12 months to 44 years (mean, 2.6 years), 104 patients were male and 76 patients were females.Results: Three patients (1.67%) died in early post-operative period. Pulmonary complications were seen in 8 (4.44%), septicemia in 1 (0.55%), low output syndrome in 2 (1.10%) and temporary arrhythmias in 6 (3.33%) patients. Reintubation was needed in 3 (1.67%) patients. Early reoperation was needed in 3 (1.67%) patients in view of post-operative bleeding. There were no mediastinal or deep sternal wound infections. None of our patient had complete heart block. There were no late deaths or late reoperations. Echocardiography before discharge did not reveal significant residual VSD in any patient. The mean right ventricular outflow tract pressure gradient was 28 mmHg (range of 20 to 44 mmHg) which decreased on follow-up echocardiography to 16 mmHg (range of 14 to 24 mmHg) at mean follow up of 23 months. None of our patient had severe pulmonary or tricuspid regurgitation or severe right ventricular dysfunction on follow up.Conclusions: Transatrial repair of TOF is associated with remarkably low morbidity and mortality in our early experience.
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Banday et al. (2020) conducted an observational in Tetralogy of Fallot (n=180). Transatrial approach for total correction of tetralogy of Fallot was evaluated on Early post-operative mortality. Transatrial repair of tetralogy of Fallot was associated with a low early mortality rate of 1.67% and a reduction in mean right ventricular outflow tract gradient to 16 mmHg at 23 months follow-up.
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