SURGERY OF TETRALOGY OF FALLOT-15 YEAR EXPERIENCE AT AFIC-NIHD RAWALPINDI

Syed Shahid Nafees Zaidi; Inamullah Khan; Nausheen Bakht; Syeda Aliza Shahid; Khurram Akhtar; Hajira Akbar; Amjad Mahmood; Intisar Ul Haq; Nadeem Sadiq; Dawood Kamal; Hafsa Khalil

doi:10.51253/pafmj.v70iSuppl-4.6048

Authors

Syed Shahid Nafees Zaidi Armed Forces Institute of Cardiology/National Institute of Heart Disease (AFIC/NIHD)/National University of Medical Sciences (NUMS) Rawalpindi Pakistan
Inamullah Khan Armed Forces Institute of Cardiology/National Institute of Heart Disease (AFIC/NIHD)/National University of Medical Sciences (NUMS) Rawalpindi Pakistan
Nausheen Bakht Armed Forces Post Graduate Medical Institute/National University of Medical Sciences (NUMS) Rawalpindi Pakistan
Syeda Aliza Shahid CMH Lahore Medical College, Lahore/National University of Medical Sciences (NUMS) Pakistan
Khurram Akhtar Armed Forces Institute of Cardiology/National Institute of Heart Disease (AFIC/NIHD)/National University of Medical Sciences (NUMS) Rawalpindi Pakistan
Hajira Akbar Armed Forces Institute of Cardiology/National Institute of Heart Disease (AFIC/NIHD)/National University of Medical Sciences (NUMS) Rawalpindi Pakistan
Amjad Mahmood Armed Forces Institute of Cardiology/National Institute of Heart Disease (AFIC/NIHD)/National University of Medical Sciences (NUMS) Rawalpindi Pakistan
Intisar Ul Haq Armed Forces Institute of Cardiology/National Institute of Heart Disease (AFIC/NIHD)/National University of Medical Sciences (NUMS) Rawalpindi Pakistan
Nadeem Sadiq Armed Forces Institute of Cardiology/National Institute of Heart Disease (AFIC/NIHD)/National University of Medical Sciences (NUMS) Rawalpindi Pakistan
Dawood Kamal Armed Forces Institute of Cardiology/National Institute of Heart Disease (AFIC/NIHD)/National University of Medical Sciences (NUMS) Rawalpindi Pakistan
Hafsa Khalil Armed Forces Institute of Cardiology/National Institute of Heart Disease (AFIC/NIHD)/National University of Medical Sciences (NUMS) Rawalpindi Pakistan

DOI:

https://doi.org/10.51253/pafmj.v70iSuppl-4.6048

Keywords:

Tetralogy of fallot, Trans-atrial/trans-pulmonary repair, Trans-annular patch/trans-venrticular repair, Total correction of tetralogy of fallot

Abstract

Objective: To compare trans-atrial/Trans-pulmonary and trans-annular/trans-ventricular techniques of surgical correction of tetralogy of fallot.

Study Design: Descriptive cross sectional study.

Place and Duration of Study: AFIC-NIHD Rawalpindi, from Jan 2005 to Jan 2020.

Methodology: Pre-op variables included age, gender, weight, SaO2 and any previous operation (like Modified Blalock Taussig Shunt.) Operative variables were any previous Blalock Taussig Shunts and if present, then their takedown, Cardiopulmonary Bypass Time, Aortic Clamp Time, any Right Ventricle - Pulmonary Artery conduit, Main Pulmonary Artery patch-plasty, Left Pulmonary Artery/ Right Pulmonary Artery patch-plasty, dosage of inotropes and pacing started during weaning off CPB. Post-op variables were mechanical ventilation time (hrs), ventilation time >72 hrs, dosage and duration of inotropes, pacing >24 hrs, renal complications, neurological complications, sepsis, low cardiac output, re-ventilation, tachyarrythmias, any re-opening surgery, mean intensive care unit stay (hrs), overall hospital stay (days) and overall all-cause mortality.

Results: A total of 1271 TOF patients were operated. In (38.6%) cases Trans-atrial / Trans-pulmonary approach was used while in 780 (61.3%) correction was done by TAP/TV technique. In both techniques, male patients were 365 (66.4%) vs. 73 (64.1%) females. Mean age was 5 ± 2.3 vs. 4 ± 2.5 years, MPA patch-plasty was 190 ± 5 (38.6%) vs. 780 ± 8 (100%) (p-0.058), RPA/LPA Patch Plasty was 25 ± 6 (5%) vs. 180 ± 10 (23%) (p- 0.025), In ICU, Ventilation hours was 25 ± 8 and 30 ± 12, Ventilation >72 Hrs was 15 (3%) vs. 65 (8.3%) (p-0.015), Inotrope duration >72 Hours was 90 (18.3%) vs. 400 (51.2%) (p-0.338), pacing >24 hours was 30 (6.1%) vs. 150 (19.2%) (p-0.0001), renal complications were 10 (2.3%) vs. 35 (4.4%) (p- 0.285), Neurological complications were 7 (1.4%) vs. 15 (1.9%) (p0.553), Sepsis was 11 (2.2%) vs. 47 (6%) (p-0.33), Low cardiac output was 15 (3%) vs. 66 (8.4%) (p- 1.000), re-ventilation was 10 (2%) vs. 110 (14%) (p- 0.41), Tachy-arrhythmia was 25 (5%) vs. 150 (19.2%) (p- 0.11), re-openings were 19 (3.8%) vs. 65 (8.3%) (p- 0.0003), ICU stay (Hours) was 87 ± 8 vs. 108 ± 10, Mortality was 35 (7.1%) vs. 75 (9.6%) (p-0.094), Mean hospital stay (Days) was 12.2 ± 2.5 vs. 15.8 ± 4.9.

Conclusion: Fifteen years’ experience of Tetralogy of fallot corrections at AFIC-NIHD indicates that Trans-atrial / Trans-pulmonary approach is more beneficial to patients due to high survival rate, less morbidity, less hospital stay and an early discharge. This ultimately translates into less financial burden on the patients, hospital, society and the country at large.