Young Infants with Severe Tetralogy of Fallot: Early Primary Surgery versus Transcatheter Palliation

Abstract Background Infants with severe tetralogy of Fallot (TOF) may undergo: 1) early primary surgical repair (EARLY) or 2) early transcatheter palliation (CATH) before delayed surgical repair. We compared these strategies to 3) elective single-stage TOF repair (IDEAL). Methods From 2000-2012, 453 children underwent TOF repair (excluding systemic-pulmonary shunts), including: 383 IDEAL (75%), 42 EARLY (9%) and 28 CATH (6%). IDEAL repair at our institution occurs after 3-months. Risk-adjusted hazard analysis compared freedom from surgical or catheter re-intervention. Somatic size, branch pulmonary artery (BPA) size and right-ventricle systolic pressure (RVSP) were modeled using 2780 echocardiogram reports via mixed-model regression. Results CATH involved: RVOT-stent=18, RVOT-balloon=9 and ductal-stent=1. There were 3 total deaths (one per group). Risk-adjusted freedom from surgical reoperation was 89±4%, 88±5% and 85±6% for IDEAL, EARLY and CATH respectively, at 10-years. EARLY and CATH had similar reoperation rates, except for neonates (