Nestor Sandoval1, Marisol Carreño2, William M Novick3, Ravi Agarwal4, Iftikhar Ahmed5, Rakhi Balachandran6, Maria Balestrini7, K M Cherian8, Ulisses Croti9, Xinwei Du10, Kimberlee Gauvreau11, Do Thi Cam Giang12, Ramkinkar Shastri13, Kathy J Jenkins11. 1. Department of Cardiac Surgery, Fundación Cardioinfantil-Instituto de Cardiología, Congenital Heart Institute, Universidad del Rosario, Bogotá, Colombia. Electronic address: nsandoval@cardioinfantil.org. 2. Department of Cardiac Surgery, Fundación Cardioinfantil-Instituto de Cardiología, Congenital Heart Institute, Universidad del Rosario, Bogotá, Colombia. 3. William Novick Global Cardiac Alliance, Memphis, Tennessee; Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee. 4. Department of Cardiac Surgery, Madras Medical Mission, Chennai, India. 5. Department of Anesthesia, Armed Forces Institute of Cardiology, National Institute of Heart Disease, Rawalpindi, Pakistan. 6. Department of Cardiac Anesthesia and Pediatric Cardiac Critical Care, Amrita Institute of Medical Science, Kochi, India. 7. Department of Pediatric Cardiac Intensive Care, Hospital Garrahan, Buenos Aires, Argentina. 8. Department of Cardiac Surgery, Frontier Lifeline Hospital, Chennai, India. 9. Department of Pediatric Cardiovascular Surgery, Hospital da Criança e Maternidade, Sao Jose do Rio Preto, Brazil. 10. Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, Shanghai, China. 11. Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts. 12. Department of Pediatric Cardiology, Nhi Dong 1, Ho Chi Minh City, Vietnam. 13. Department of Pediatric Cardiac Surgery, Star Hospital, Hyderabad, India.
Abstract
BACKGROUND: Isolated reports from low- and middle-income countries (LMICs) for surgical results in tetralogy of Fallot (TOF) are available. The International Quality Improvement Collaborative for Congenital Heart Disease (IQIC) seeks to improve surgical results promoting reductions in infection and mortality in LMICs. METHODS: All cases of TOF in the IQIC database performed between 2010 and 2014 at 32 centers in 20 LMICs were included. Excluded from the analysis were TOF with any associated lesions. A logistic regression analysis was performed to identify risk factors for in-hospital mortality after surgery for TOF. RESULTS: A total of 2,164 patients were identified. There were 1,839 initial primary repairs, 200 with initial systemic-to-pulmonary artery shunt, and 125 underwent secondary repair after initial palliation. Overall mortality was 3.6% (78 of 2,164), initial primary repair was 3.3% (60 of 1,839), initial systemic-to-pulmonary artery shunt was 8.0% (16 of 200), and secondary repair was 1.6% (2 of 125; p = 0.003). Major infections occurred in 5.9% (128 of 2,164) of the entire cohort. Risk factors for death after the initial primary repair were oxygen saturation less than 90% and weight/body mass index for age below the fifth percentile (p < 0.001). The initial primary repair occurred after age 1 year in 54% (991 of 1,839). Older age at initial primary repair was not a risk factor for death (p = 0.21). CONCLUSIONS: TOF patients are often operated on after age 1 year in LMICs. Unlike in developed countries, older age is not a risk factor for death. Nutritional and hypoxemic status were associated with higher mortality and infection. This information fills a critical knowledge gap for surgery in LMIC.
BACKGROUND: Isolated reports from low- and middle-income countries (LMICs) for surgical results in tetralogy of Fallot (TOF) are available. The International Quality Improvement Collaborative for Congenital Heart Disease (IQIC) seeks to improve surgical results promoting reductions in infection and mortality in LMICs. METHODS: All cases of TOF in the IQIC database performed between 2010 and 2014 at 32 centers in 20 LMICs were included. Excluded from the analysis were TOF with any associated lesions. A logistic regression analysis was performed to identify risk factors for in-hospital mortality after surgery for TOF. RESULTS: A total of 2,164 patients were identified. There were 1,839 initial primary repairs, 200 with initial systemic-to-pulmonary artery shunt, and 125 underwent secondary repair after initial palliation. Overall mortality was 3.6% (78 of 2,164), initial primary repair was 3.3% (60 of 1,839), initial systemic-to-pulmonary artery shunt was 8.0% (16 of 200), and secondary repair was 1.6% (2 of 125; p = 0.003). Major infections occurred in 5.9% (128 of 2,164) of the entire cohort. Risk factors for death after the initial primary repair were oxygen saturation less than 90% and weight/body mass index for age below the fifth percentile (p < 0.001). The initial primary repair occurred after age 1 year in 54% (991 of 1,839). Older age at initial primary repair was not a risk factor for death (p = 0.21). CONCLUSIONS: TOF patients are often operated on after age 1 year in LMICs. Unlike in developed countries, older age is not a risk factor for death. Nutritional and hypoxemic status were associated with higher mortality and infection. This information fills a critical knowledge gap for surgery in LMIC.
Authors: Albert Franz Guerrero; Ivonne Gisel Pineda-Rodríguez; Andres Mauricio Palacio; Carlos Eduardo Obando; Tomas Chalela; Jaime Camacho; Carlos Villa; Juan Pablo Umaña; Nestor Fernando Sandoval-Reyes Journal: Interact Cardiovasc Thorac Surg Date: 2022-07-09