Medical Journal of The Islamic Republic of Iran (MJIRI)

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In order to compare early post-operative results in primary versus two-stage repair of tetralogy of Fallot at Shiraz University of Medical Sciences, one􀁱hundred and eleven patients with tetralogy of Fallot with right ventricle to pulmonary artery continuity and no other major associated anomaly were repaired in one center by one surgeon in a one or two-stage protocol. Those patients who were initially palliated with shunt were either referred from other centers for total correction, presented with cyanotic spells, or were shunted due to their severe and diffuse right ventricular outflow tract obstruction or pulmonary artery branch stenosis or hypoplasia. Hospital mortality and ratio of right to left ventricle pressure after correction were compared between the primary and the two-stage groups as early outcome indices. The patients were also divided to those who needed a trans-annular (TAP) or a sub-annular patch and were compared. In the primary group, 25 (37.3%) of the patients needed TAP, while in the two-stage group 28 (63.6%) needed TAP. Requirement for TAP was increased significantly with two-stage correction (p= 0.006, relative risk= 1.71, 95% CI= 1.16-2.5). Mortality was significantly higher in the primary group (p= 0.03, relative risk= 3.94, 95% CI= 0.93-16.76). In the primary group TAP significantly increased the mortality risk (p= 0.006, relative risk= 5.04, 95% CI= 1.5-16.89). In the two-stage group, there was no significant difference in the mortality rate between the patients with and without TAP. The TAP group had statistically significant less time interval between shunt and total correction. Our patients generally did better on two-stage repair, because of their older age at operation. The long period of low pulmonary blood flow has induced unbalanced. ventricles for them and exaggerated right ventricular outflow tract obstruction due to muscle hypertrophy. In such patients, shunting will prepare the left ventricle for accepting the extra blood volume that will reach it after total correction.

Keywords: Tetralogy of Fallot; Surgery; Treatment outcome.

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