The impact of a residual atrial communication in patients undergoing complete repair for tetralogy of Fallot: A propensity score-matched analysis.

Autor:	Moroi MK; Section of Pediatric and Congenital Cardiac Surgery, Department of Surgery, NewYork Presbyterian-Morgan Stanley Children's Hospital, New York, NY., Vinogradsky AV; Section of Pediatric and Congenital Cardiac Surgery, Department of Surgery, NewYork Presbyterian-Morgan Stanley Children's Hospital, New York, NY., Nguyen SN; Section of Pediatric and Congenital Cardiac Surgery, Department of Surgery, NewYork Presbyterian-Morgan Stanley Children's Hospital, New York, NY., Choudhury TA; Division of Pediatric Critical Care Medicine, Department of Pediatrics, NewYork Presbyterian-Morgan Stanley Children's Hospital, New York, NY; Division of Cardiology, Department of Pediatrics, NewYork Presbyterian-Morgan Stanley Children's Hospital, New York, NY., Krishnamurthy G; Division of Neonatology, Department of Pediatrics, NewYork Presbyterian-Morgan Stanley Children's Hospital, New York, NY., Kalfa D; Section of Pediatric and Congenital Cardiac Surgery, Department of Surgery, NewYork Presbyterian-Morgan Stanley Children's Hospital, New York, NY., Bacha EA; Section of Pediatric and Congenital Cardiac Surgery, Department of Surgery, NewYork Presbyterian-Morgan Stanley Children's Hospital, New York, NY., Levasseur S; Division of Cardiology, Department of Pediatrics, NewYork Presbyterian-Morgan Stanley Children's Hospital, New York, NY., Goldstone AB; Section of Pediatric and Congenital Cardiac Surgery, Department of Surgery, NewYork Presbyterian-Morgan Stanley Children's Hospital, New York, NY. Electronic address: abg2191@cumc.columbia.edu.
Jazyk:	angličtina
Zdroj:	The Journal of thoracic and cardiovascular surgery [J Thorac Cardiovasc Surg] 2024 Oct 03. Date of Electronic Publication: 2024 Oct 03.
DOI:	10.1016/j.jtcvs.2024.09.046
Abstrakt:	Background: Surgeons may leave a residual atrial-level communication during complete repair of tetralogy of Fallot (TOF) in anticipation of restrictive right ventricle physiology or as routine practice. We investigated the impact of closing the interatrial communication at the time of definitive TOF repair. Methods: We retrospectively reviewed TOF patients who underwent definitive repair at age <12 months between June 2000 and January 2023. Propensity score matching identified 82 patients with a patent interatrial communication and 50 patients with no interatrial communication on postoperative echocardiography (as-treated analysis). The primary endpoint was maximum vasoactive-inotropic score (VIS) as a surrogate for low cardiac output syndrome. Results: A total of 132 patients (median age, 3.5 months; interquartile range [IQR], 1.8-5.8 months) were matched. There was no difference in maximum VIS (patent interatrial communication: 5.0 [IQR, 4.8-9.0] vs no interatrial communication: 6.0 [IQR, 5.0-8.0]; P = .78). Additionally, the duration of inotrope therapy (3.0 [IQR, 2.0-4.0] days vs 3.0 [IQR, 1.3-4.0] days; P = .57), peak lactate (2.2 [IQR, 1.9-3.0] mmol/L vs 2.3 [IQR, 1.9-3.2] mmol/L; P = .58), time to lactate clearance (0.2 [IQR, 0.0-0.3] days vs 0.1 [IQR, 0.0-0.3] days; P = .57), chest tube duration (4.0 [IQR, 3.0-6.0] days vs 4.0 [IQR, 3.0-5.0] days; P = .23), and length of intensive care unit stay (5.0 [IQR, 3.0-7.0] days vs 5.0 [IQR, 3.0-7.0] days; P = .71) were similar in the 2 groups. The median duration of follow-up was 5.5 years (IQR, 2.7-9.9 years). Among patients with a residual communication, patency rates were 93.6% at discharge and 53.7% at latest follow-up, with most having bidirectional shunting across the defect. Conclusions: Closure of the atrial-level communication during complete TOF repair does not significantly impact the immediate postoperative course or mid-term outcomes. Further investigation is warranted to better understand how patency influences long-term outcomes. Competing Interests: Conflict of Interest Statement The authors reported no conflicts of interest. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest. (Copyright © 2024 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)
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