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J Thorac Cardiovasc Surg 2003;126:703-710
© 2003 The American Association for Thoracic Surgery

Surgery for congenital heart disease

The influence of perioperative factors on outcomes in children aged less than 18 months after repair of tetralogy of Fallot

^a Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
^b Division of Cardiology, The Hospital for Sick Children, Toronto, Ontario, Canada
^c Division of Cardiovascular Surgery,The Hospital for Sick Children, Toronto, Ontario, Canada, Canada

Received for publication June 18, 2002; revisions received July 22, 2002; revisions received August 7, 2002; accepted for publication August 27, 2002.

^* Address for reprints: Dr Desmond Bohn, The Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, Ontario, M5G 1X8 Canada, USA
dbohn{at}sickkids.on.ca

OBJECTIVES: To determine the impact of age at repair in patients with tetralogy of Fallot on early postoperative morbidity.

METHODS: All patients less than 19 months of age (median age, 8 months; range, 36 days-18.5 months) who underwent complete repair of tetralogy of Fallot between January 1997 and December 1999 were reviewed. Data were analyzed on the preoperative clinical and anatomical characteristics, operative procedure and postoperative course in the intensive care unit. Independent factors associated with intensive care unit stay were sought using Cox’s proportionate hazard modeling. In addition, independent factors associated with an intensive care unit stay of more than 2 days were sought in multiple logistic regression analysis.

RESULTS: Seventy-eight patients underwent surgical repair; 3 had (4%) had a previous systemic to pulmonary arterial shunt. There was no operative mortality. One late death occurred. The median intensive care unit length of stay and mechanical ventilation time were 2 days (range, 1-14) and 16.2 hours (range, 0-267), respectively. Age less than 3 months was associated with increased use of vasoactive drugs, higher postoperative fluid requirement, and a higher incidence of organ dysfunction but no patient required renal replacement therapy. The duration of ventilator support and the intensive care unit length of stay were also longer in this age group.

CONCLUSIONS: Primary repair at an early age has excellent short-term outcome. Patients less than 3 months of age have an increased but transient intensive care unit morbidity.