Factors associated with perioperative mortality in children and adolescents operated for tetralogy of Fallot: A sub‐Saharan experience

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 m...

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Published in:	Journal of cardiac surgery Vol. 34; no. 12; pp. 1478 - 1485
Main Authors:	Tefera, Endale, Gedlu, Etsegenet, Nega, Berhanu, Tadesse, Birkneh T., Chanie, Yilkal, Dawoud, Ali, Moges, Fekadesilassie H., Bezabih, Abebe, Moges, Tamirat, Centella, Tomasa, Marianeschi, Stefano, Coca, Ana, Collado, Raquel, Kassa, Mamo W., Johansson, Sune, Doorn, Carin, Barber, Brent J., Teodori, Michael
Format:	Journal Article
Language:	English
Published:	United States 01-12-2019
Subjects:	cardiac surgical missions congenital heart disease Medicin och hälsovetenskap perioperative mortality sub‐Saharan setting tetralogy of fallot congenital heart disease perioperative mortality cardiac surgical missions sub-Saharan setting tetralogy of fallot
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Summary:	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.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0886-0440 1540-8191 1540-8191
DOI:	10.1111/jocs.14270