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Tetralogy of Fallot: Neonatal Versus Late Surgical Intervention, and Growth In the First Year of Life

Friday, October 19, 2012: 4:15 PM
Room 275-277 (Morial Convention Center)
Kristal L. Woldu, MD1, Bhawna Arya, MD2 and Ismee A. Williams, MD, MS2, (1)Pediatrics, New York Presbyterian/Columbia University Medical Center, New York, NY, (2)Division of Pediatric Cardiology, New York Presbyterian-Columbia and Cornell Hospitals, New York, NY

Purpose: Tetralogy of Fallot (TOF) represents approximately 10% of congenital cardiac malformations.  The type and timing of surgical intervention has changed overtime, currently with most patients undergoing repair in the first year of life.  The optimal timing of surgical intervention remains controversial.  In this study we aim to determine if there is a difference in weight (wt) at 1 year between those patients who undergo surgical intervention in the neonatal period versus those that have surgery later in the first year of life. 

Methods: A retrospective review of infants admitted to our institution with TOF between 1/2004 and 6/2011 was conducted.  Operative data and patient characteristics including weight (wt) were collected throughout the first year of life.  Differences between the early vs. the later repair groups were assessed using a student’s tor a Mann-Whitney U test.

Results: Of the 153 infants admitted with TOF, 100(65%) were determined to be non-ductal dependent, 27(18%) had simple TOF/PA, 20(13%) were TOF/MAPCAS, 9(6%) were TOF/AVC, 47(31%) had a genetic syndrome (N=15(10%) DiGeorge, N=14(9%) T21).  Of this group 70(46%) underwent neonatal surgical intervention; 40(26%) had a full repair at that time. There was no significant difference in gestational age (GA) between the early and the later repair groups (38.2±1.8 vs. 37.3±2.8 wk, p=0.05) however birth wt was higher in the early group (3.1±.7 vs. 2.7±.7 kg, p=0.007).  There was no difference in total bypass time (121±51 vs. 103±87 min, p=0.3) or total number of days intubated (7.5±5.6 vs. 5.5±8.1 d, p=0.09) between the early and later groups.  Median length of stay was longer in the early repair group (19[6-141] vs. 15[1-253] d, p=0.04).  Wt at 1yr±2mo of age was available in 97 (63%) subjects; 10 (6.5%) died and 46 (28%) did not have a wt in window. The mean wt-for-age z-scores at 1 year for the early vs. later full repair group were -0.49 and -1.2, respectively (p=0.04). When we excluded patients with genetic syndrome from the analysis (N=74), mean z-scores were -0.4 vs. -1.0 early vs. later (p=0.09). 

Conclusion: TOF patients who undergo early repair have slightly higher wt-for-age z-scores at 1 year.  This may be due to amelioration of cyanosis earlier in the first year of life.