ผลการรักษาผู้ป่วยหลังการผ่าตัดหัวใจชนิด Tetralogy of Fallot ในโรงพยาบาลมหาราชนครเชียงใหม่

Silvilairat S; Tanetsakulwatana N; Kamsap N; Jewreungwinyu T; Watthanayanont N; Chanyutthana S; Sethasathien S

Authors

Silvilairat S Department of Pediatrics, Faculty of Medicine
Tanetsakulwatana N Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
Kamsap N Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
Jewreungwinyu T Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
Watthanayanont N Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
Chanyutthana S Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
Sethasathien S Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand

Keywords:

Tetralogy of Fallot, total correction, RV to PA conduit, outcome, mortality

Abstract

Background: Total correction has been performed in patients with tetralogy of Fallot (TOF) to prevent early death from systemic hypoxemia. However, short- and long-term complications are the major concerns in Thai patients due to insufficient data and loss of follow-up.

Objectives: The aim of this study was to identify the survival rate and predictors for the mortality of patients with TOF after total correction.

Methods: We included all patients with TOF who had undergone total correction between 1993 and 2020. Medical records were reviewed for patient demographics, operative details and complications. Patients who were diagnosed with double outlet right ventricle (TOF type), lost follow-up or missing data were excluded.

Results: A total of 638 patients were included (57.5% male patients, 15.2% TOF with pulmonary atresia, 10.2% genetic abnormalities, 7.2% right ventricle to pulmonary artery conduit). The median age at total correction of TOF was 4.4 years ( IQR; 2.9-7.4 years). Early and late events developed in 109 (17.1%) and 320 patients (50.2%). The 25-year survival rate was 90%. The crude mortality rate was 7.1%. Multivariate cox regression analysis demonstrated genetic abnormality (HR 3.18 [95%CI 1.61-6.29], p=0.001) and RV to PA conduit utilization (HR 3.29 [95%CI 1.53-7.10], p=0.002) were the predictors for mortality.

Conclusions:The survival rate was 90% after repaired TOF. The presence of genetic abnormality and RV to PA conduit operation were the predictors of the mortality.

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