Which is the best approach to repair tetralogy of Fallot -ten years' experience in Shanghai Children Medical Cente

  • Dr Huiwen Chen, Department of Pediatric Cardiothoracic Surgery, Shanghai Children’s Medical Center, Shanghai Jiaotong University, Shanghaiʌ, China
  • Dr Zhiwei Xu, Department of Pediatric Cardiothoracic Surgery, Shanghai Children’s Medical Center, Shanghai Jiaotong University, Shanghaiʌ, China

    • Objective: Transatrial repair of tetralogy of Fallot (TOF) has become a standard procedure at any age.Elective repair is generally recommended between 3 and 6 months of life.Delayed presentation in China further compound disease severity.Secondary hypertrophy in the right ventricule and small pulmonary valve ring make difficulty by transatrial approach. Transatrial with minimal right ventriculotomy approach (RA-RV) was performed since 2000.To compare the perioperative outcomes with tranvebtricular and transatrial-transventricular approach to TOF.
    Methods:Fifteen hundreds and fifteen consecutive patients who underwent complete repair of tetralogy of Fallot between January 1998 and December 2007 were reviewed.
    Results:Patients by transventricular approach decreased from 88% in 1998 to 57% in 2002. Transatrial-transventricular approach increased from 38% in 2002 to 61% in 2003,77% in 2007. Patients by transatrial-transventricular approach had less aortic clamp time and CPB time than transventricular approach. No difference in transannular patch ratio. Patients by transatrial-transventricular approach were better in the median ICU length of stay and mechanical ventilation time 3 ICU ,residual VSD,RV-MPA pressure gradient,TR,PI and JET than transventricular approach. No difference in MOF. Patients by transatrial-transventricular approach had lower morbidity in one to two organ systems dysfunction than transventricular approach. No difference in 3 or more organ systems dysfunction between them. Reoperative and mortality in patients by transatrial-transventricular approach less than transventricular approach..
    Conclusions:Transatrial-transventricular approach to repair TOF fits to actual conditions in China.