Endale Tefera1, Etsegenet Gedlu2, Berhanu Nega3, Birkneh T Tadesse4, Yilkal Chanie5, Ali Dawoud5, Fekadesilassie H Moges6, Abebe Bezabih3, Tamirat Moges2, Tomasa Centella7, Stefano Marianeschi8, Ana Coca7, Raquel Collado7, Mamo W Kassa9, Sune Johansson10, Carin van Doorn11, Brent J Barber12, Michael Teodori13. 1. Division of Cardiology, Department of Pediatrics and Adolescent Health, Faculty of Medicine, University of Botswana, Gaborone, Botswana. 2. Division of Cardiology, Department of Pediatrics and Child Health, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia. 3. Department of Surgery, Cardiothoracic Unit, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia. 4. Department of Pediatrics and Child Health, College of Health Sciences, Hawassa University, Hawassa, Ethiopia. 5. Division of Pediatric Cardiology, Children's Heart Fund Cardiac Center, Addis Ababa, Ethiopia. 6. Department of Internal Medicine, Aurora Healthcare, Milwaukee, Wisconsin, USA. 7. Department of Congenital Heart Disease, Ramon y Cajal University Hospital, Madrid, Spain. 8. Department of Cardiothoracic Surgery, Pediatric Cardiac Surgery Unit, Niguarda Hospital, Milan, Italy. 9. Department of Anaesthesiology, Faculty of Medicine, University of Botswana, Gaborone, Botswana. 10. Department of Pediatric Cardiac Surgery, Skane University Hospital, Lund, Sweden. 11. Congenital Cardiac Unit, Leeds Teaching Hospital NHS Trust, Leeds, United Kingdom. 12. Division of Cardiology, Department of Pediatrics, College of Medicine, University of Arizona, Tucson, Arizona, USA. 13. Pediatric and Adult Congenital Heart Surgery Division, Department of Surgery, University of Arizona, Tucson, Arizona, USA.
Abstract
BACKGROUND: Patients with tetralogy of Fallot are now surviving to adulthood with timely surgical intervention. However, many patients in low-income countries have no access to surgical intervention. This paper reports the surgical access and perioperative mortality in a sub-Saharan center that was mainly dependent on visiting teams. METHODS: We reviewed records of patients operated from January 2009 to December 2014. We examined perioperative outcomes, primarily focusing on factors associated with perioperative mortality. RESULTS: During this period, 62 patients underwent surgery. Fifty-seven (91.9%) underwent primary repair, while 5 (6.5%) underwent palliative shunt surgery. Of the five patients with shunt surgery, four ultimately underwent total repair. Eight (12.9%) patients died during the perioperative period. Factors associated with perioperative mortality include repeated preoperative phlebotomy procedures (P < .001), repeated runs and long cardiopulmonary bypass time (P < .001), and aortic cross-clamp time (P < .001), narrow pulmonary artery (PA) valve annulus diameter (P = .022), narrow distal main PA diameter (P = .039), narrow left branch PA diameter (P = .049), and narrow right PA diameter (P = .039). Of these factors, cardiopulmonary bypass time/aortic cross-clamp time and pulmonary valve annulus diameter less than three SD were independently associated with perioperative mortality. CONCLUSION: In this series of consecutive patients operated by a variety of humanitarian surgical teams, cardiopulmonary bypass time/aortic cross-clamp time, and pulmonary valve annulus diameter less than three SD were independently associated with perioperative mortality risk. As some of these factors are modifiable, we suggest that they should be considered during patient selection and at the time of surgical intervention.
BACKGROUND:Patients with tetralogy of Fallot are now surviving to adulthood with timely surgical intervention. However, many patients in low-income countries have no access to surgical intervention. This paper reports the surgical access and perioperative mortality in a sub-Saharan center that was mainly dependent on visiting teams. METHODS: We reviewed records of patients operated from January 2009 to December 2014. We examined perioperative outcomes, primarily focusing on factors associated with perioperative mortality. RESULTS: During this period, 62 patients underwent surgery. Fifty-seven (91.9%) underwent primary repair, while 5 (6.5%) underwent palliative shunt surgery. Of the five patients with shunt surgery, four ultimately underwent total repair. Eight (12.9%) patients died during the perioperative period. Factors associated with perioperative mortality include repeated preoperative phlebotomy procedures (P < .001), repeated runs and long cardiopulmonary bypass time (P < .001), and aortic cross-clamp time (P < .001), narrow pulmonary artery (PA) valve annulus diameter (P = .022), narrow distal main PA diameter (P = .039), narrow left branch PA diameter (P = .049), and narrow right PA diameter (P = .039). Of these factors, cardiopulmonary bypass time/aortic cross-clamp time and pulmonary valve annulus diameter less than three SD were independently associated with perioperative mortality. CONCLUSION: In this series of consecutive patients operated by a variety of humanitarian surgical teams, cardiopulmonary bypass time/aortic cross-clamp time, and pulmonary valve annulus diameter less than three SD were independently associated with perioperative mortality risk. As some of these factors are modifiable, we suggest that they should be considered during patient selection and at the time of surgical intervention.