Primary or Delayed Repair for Complete Atrioventricular Septal Defect, Tetralogy of Fallot, and Ventricular Septal Defect: Relationship to Country Economic Status.
| Autor: | Bateson BP; Department of Surgery, Augusta University, Augusta, GA, USA., Deng L; Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA., Ange B; Department of Surgery, Augusta University, Augusta, GA, USA., Austin E; Department of Cardiovascular and Thoracic Surgery, University of Louisville, Louisville, KY, USA., Dabal R; Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA., Bowser T; Kirklin Solutions Inc. Birmingham, AL, USA., Pennington J; Kirklin Solutions Inc. Birmingham, AL, USA., Sivakumar S; Department of Cardiothoracic Surgery, National Heart Institute, Kuala Lumpur, Malaysia., Lee C; Department of Thoracic and Cardiovascular Surgery, Seoul St.Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea., Truong NLT; Department of Cardiovascular Surgery, National Children Hospital, Hanoi, Vietnam., Jacobs J; Department of Surgery, University of Florida, Gainesville, FL, USA., Cervantes J; Department of Surgery, Instituto Nacional de Cardiologia, Mexico City, Mexico., Jagannath BR; Department of Cardiovascular and Thoracic Surgery, Star Hospital, Banjara Hills, India., Jonas RA; Department of Pediatric Cardiac Surgery, Children's National, Washington D.C., USA., Kirklin JK; Kirklin Solutions Inc. Birmingham, AL, USA., St Louis J; Department of Surgery, Augusta University, Augusta, GA, USA. |
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| Jazyk: | angličtina |
| Zdroj: | World journal for pediatric & congenital heart surgery [World J Pediatr Congenit Heart Surg] 2024 Jan; Vol. 15 (1), pp. 11-18. Date of Electronic Publication: 2023 Oct 30. |
| DOI: | 10.1177/21501351231204333 |
| Abstrakt: | Objective: Primary repair in the first six months of life is routine for tetralogy of Fallot, complete atrioventricular septal defect, and ventricular septal defect in high-income countries. The objective of this analysis was to understand the utilization and outcomes of palliative and reparative procedures in high versus middle-income countries. Methods: The World Database of Pediatric and Congenital Heart Surgery identified patients who underwent surgery for: tetralogy of Fallot, complete atrioventricular septal defect, and ventricular septal defect. Patients were categorized as undergoing primary repair, repair after prior palliation, or palliation only. Country economic status was categorized as lower middle, upper middle, and high, defined by the World Bank. Multiple logistic regression models were utilized to identify independent predictors of hospital mortality. Results: Economic categories included high (n = 571, 5.3%), upper middle (n = 5,342, 50%), and lower middle (n = 4,793, 49.7%). The proportion of patients and median age with primary repair were: tetralogy of Fallot, 88.6%, 17.7 months; complete atrioventricular septal defect, 83.4%, 7.7 months; and ventricular septal defect, 97.1%, ten months. Age at repair was younger in high income countries ( P < .0001). Overall mortality after repair was lowest in high income countries. Risk factors for hospital mortality included prematurity, genetic syndromes, and urgent or emergent operations (all P < .05). Conclusions: Primary repair was selected in >90% of patients, but definitive repair was delayed in lower and upper middle income countries compared with high-income countries. Repair after prior palliation versus primary repair was not a risk factor for hospital mortality. Initial palliation continues to have a small but important role in the management of these three specific congenital heart defects. Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. |
| Databáze: | MEDLINE |
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