Adults With Tetralogy of Fallot: Early Postoperative Outcomes and Risk Factors for Complications
To report the early postoperative outcomes in adults with tetralogy of Fallot (TOF) undergoing cardiac surgery and to identify patient factors associated with complications. We performed a single-institution retrospective review of adults with TOF who underwent cardiac surgery from January 8, 2008,...
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| Veröffentlicht in: | Mayo Clinic proceedings 2021-09, Vol.96 (9), p.2398-2406 |
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| creator | Hu, Jessie J. Bonnichsen, Crystal R. Dearani, Joseph A. Miranda, William R. Johnson, Jonathan N. Cetta, Frank Stephens, Elizabeth H. Aganga, Devon O. Van Dorn, Charlotte S. |
| description | To report the early postoperative outcomes in adults with tetralogy of Fallot (TOF) undergoing cardiac surgery and to identify patient factors associated with complications.
We performed a single-institution retrospective review of adults with TOF who underwent cardiac surgery from January 8, 2008, through June 21, 2018. Patients’ characteristics, preoperative imaging, surgical interventions, outcomes, and complications were analyzed.
There were 219 adults with TOF (mean age, 40 years; range, 18-83 years; 88 [40%] female) in the study. Surgical interventions included repair or replacement of the pulmonary valve (n=199 [91%]), tricuspid valve (n=70 [32%]), mitral valve (n=13 [5.9%]), and aortic valve (n=8 [3.7%]). Three patients (1.4%) underwent first-time TOF repair. The 30-day mortality rate was 1.4% (n=3). Early postoperative complications occurred in 66 (30%) and included arrhythmias requiring treatment, dialysis requirement, liver dysfunction, respiratory failure, infection, reoperation, cardiac arrest, mechanical circulatory support, and death. Multivariate analysis found older age at current surgery (odds ratio [OR], 1.04 per year; 95% CI, 1.01 to 1.06; P |
| doi_str_mv | 10.1016/j.mayocp.2021.01.032 |
| format | Article |
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We performed a single-institution retrospective review of adults with TOF who underwent cardiac surgery from January 8, 2008, through June 21, 2018. Patients’ characteristics, preoperative imaging, surgical interventions, outcomes, and complications were analyzed.
There were 219 adults with TOF (mean age, 40 years; range, 18-83 years; 88 [40%] female) in the study. Surgical interventions included repair or replacement of the pulmonary valve (n=199 [91%]), tricuspid valve (n=70 [32%]), mitral valve (n=13 [5.9%]), and aortic valve (n=8 [3.7%]). Three patients (1.4%) underwent first-time TOF repair. The 30-day mortality rate was 1.4% (n=3). Early postoperative complications occurred in 66 (30%) and included arrhythmias requiring treatment, dialysis requirement, liver dysfunction, respiratory failure, infection, reoperation, cardiac arrest, mechanical circulatory support, and death. Multivariate analysis found older age at current surgery (odds ratio [OR], 1.04 per year; 95% CI, 1.01 to 1.06; P<.001), longer cardiopulmonary bypass time (OR, 1.01 per minute; 95% CI, 1.01 to 1.02; P<.001), right ventricular systolic dysfunction (OR, 1.31; 95%, CI 1.02 to 1.69; P=.03), diabetes mellitus (OR, 3.50; 95% CI, 1.20 to 10.2; P=.02), and history of initial palliative surgery (OR, 1.99; 95% CI, 1.01 to 3.91; P=.05) as independent predictors of complications.
Surgical interventions for adult patients with TOF can be performed with low early morbidity and mortality. Clinical characteristics and preoperative testing parameters can predict risk for complications in the postoperative period.</description><identifier>ISSN: 0025-6196</identifier><identifier>EISSN: 1942-5546</identifier><identifier>DOI: 10.1016/j.mayocp.2021.01.032</identifier><language>eng</language><publisher>Elsevier Inc</publisher><subject>Care and treatment ; Complications ; Heart ; Patient outcomes ; Surgery ; Tetralogy of Fallot</subject><ispartof>Mayo Clinic proceedings, 2021-09, Vol.96 (9), p.2398-2406</ispartof><rights>2021 Mayo Foundation for Medical Education and Research</rights><rights>COPYRIGHT 2021 Elsevier, Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c409t-b575102de90b359efa56594022414d4aa41b25a9920c1717e31cdf05a8db49853</citedby><cites>FETCH-LOGICAL-c409t-b575102de90b359efa56594022414d4aa41b25a9920c1717e31cdf05a8db49853</cites><orcidid>0000-0001-8709-6794 ; 0000-0003-3810-8933 ; 0000-0002-2664-1290 ; 0000-0001-8864-8474</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27922,27923</link.rule.ids></links><search><creatorcontrib>Hu, Jessie J.</creatorcontrib><creatorcontrib>Bonnichsen, Crystal R.</creatorcontrib><creatorcontrib>Dearani, Joseph A.</creatorcontrib><creatorcontrib>Miranda, William R.</creatorcontrib><creatorcontrib>Johnson, Jonathan N.</creatorcontrib><creatorcontrib>Cetta, Frank</creatorcontrib><creatorcontrib>Stephens, Elizabeth H.</creatorcontrib><creatorcontrib>Aganga, Devon O.</creatorcontrib><creatorcontrib>Van Dorn, Charlotte S.</creatorcontrib><title>Adults With Tetralogy of Fallot: Early Postoperative Outcomes and Risk Factors for Complications</title><title>Mayo Clinic proceedings</title><description>To report the early postoperative outcomes in adults with tetralogy of Fallot (TOF) undergoing cardiac surgery and to identify patient factors associated with complications.
We performed a single-institution retrospective review of adults with TOF who underwent cardiac surgery from January 8, 2008, through June 21, 2018. Patients’ characteristics, preoperative imaging, surgical interventions, outcomes, and complications were analyzed.
There were 219 adults with TOF (mean age, 40 years; range, 18-83 years; 88 [40%] female) in the study. Surgical interventions included repair or replacement of the pulmonary valve (n=199 [91%]), tricuspid valve (n=70 [32%]), mitral valve (n=13 [5.9%]), and aortic valve (n=8 [3.7%]). Three patients (1.4%) underwent first-time TOF repair. The 30-day mortality rate was 1.4% (n=3). Early postoperative complications occurred in 66 (30%) and included arrhythmias requiring treatment, dialysis requirement, liver dysfunction, respiratory failure, infection, reoperation, cardiac arrest, mechanical circulatory support, and death. Multivariate analysis found older age at current surgery (odds ratio [OR], 1.04 per year; 95% CI, 1.01 to 1.06; P<.001), longer cardiopulmonary bypass time (OR, 1.01 per minute; 95% CI, 1.01 to 1.02; P<.001), right ventricular systolic dysfunction (OR, 1.31; 95%, CI 1.02 to 1.69; P=.03), diabetes mellitus (OR, 3.50; 95% CI, 1.20 to 10.2; P=.02), and history of initial palliative surgery (OR, 1.99; 95% CI, 1.01 to 3.91; P=.05) as independent predictors of complications.
Surgical interventions for adult patients with TOF can be performed with low early morbidity and mortality. Clinical characteristics and preoperative testing parameters can predict risk for complications in the postoperative period.</description><subject>Care and treatment</subject><subject>Complications</subject><subject>Heart</subject><subject>Patient outcomes</subject><subject>Surgery</subject><subject>Tetralogy of Fallot</subject><issn>0025-6196</issn><issn>1942-5546</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><recordid>eNp9kcFq3DAQhkVpodtt36AHnUovdiVZslc9FJYlaQuBhJKQo9BK46y2suVKcmDfJs_SJ6tS99BcMjMwMHz_wMyP0HtKakpo--lYD_oUzFQzwmhNSjXsBVpRyVklBG9fohUhTFQtle1r9CalIyGkk5KvkN7a2eeEb10-4GvIUftwd8Khx-fa-5A_4zMd_QlfhZTDBFFndw_4cs4mDJCwHi3-4dLPQpscYsJ9iL8fdmGYvDOFDWN6i1712id496-v0c352fXuW3Vx-fX7bntRGU5krvaiE5QwC5LsGyGh16IVkhPGOOWWa83pngktJSOGdrSDhhrbE6E3ds_lRjRr9HHZO8Xwa4aU1eCSAe_1CGFOiom24axrSqxRvaB32oNyYx_K3aakhcGZMELvynzbdpsNY03bFsGH_wQH0D4fUvDz3wOfgnwBTQwpRejVFN2g40lRoh69Uke1eKUevVKkVMOK7Msig_KgewdRJeNgNGBdBJOVDe75BX8AXmOepw</recordid><startdate>202109</startdate><enddate>202109</enddate><creator>Hu, Jessie J.</creator><creator>Bonnichsen, Crystal R.</creator><creator>Dearani, Joseph A.</creator><creator>Miranda, William R.</creator><creator>Johnson, Jonathan N.</creator><creator>Cetta, Frank</creator><creator>Stephens, Elizabeth H.</creator><creator>Aganga, Devon O.</creator><creator>Van Dorn, Charlotte S.</creator><general>Elsevier Inc</general><general>Elsevier, Inc</general><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-8709-6794</orcidid><orcidid>https://orcid.org/0000-0003-3810-8933</orcidid><orcidid>https://orcid.org/0000-0002-2664-1290</orcidid><orcidid>https://orcid.org/0000-0001-8864-8474</orcidid></search><sort><creationdate>202109</creationdate><title>Adults With Tetralogy of Fallot: Early Postoperative Outcomes and Risk Factors for Complications</title><author>Hu, Jessie J. ; Bonnichsen, Crystal R. ; Dearani, Joseph A. ; Miranda, William R. ; Johnson, Jonathan N. ; Cetta, Frank ; Stephens, Elizabeth H. ; Aganga, Devon O. ; Van Dorn, Charlotte S.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c409t-b575102de90b359efa56594022414d4aa41b25a9920c1717e31cdf05a8db49853</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Care and treatment</topic><topic>Complications</topic><topic>Heart</topic><topic>Patient outcomes</topic><topic>Surgery</topic><topic>Tetralogy of Fallot</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Hu, Jessie J.</creatorcontrib><creatorcontrib>Bonnichsen, Crystal R.</creatorcontrib><creatorcontrib>Dearani, Joseph A.</creatorcontrib><creatorcontrib>Miranda, William R.</creatorcontrib><creatorcontrib>Johnson, Jonathan N.</creatorcontrib><creatorcontrib>Cetta, Frank</creatorcontrib><creatorcontrib>Stephens, Elizabeth H.</creatorcontrib><creatorcontrib>Aganga, Devon O.</creatorcontrib><creatorcontrib>Van Dorn, Charlotte S.</creatorcontrib><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Mayo Clinic proceedings</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hu, Jessie J.</au><au>Bonnichsen, Crystal R.</au><au>Dearani, Joseph A.</au><au>Miranda, William R.</au><au>Johnson, Jonathan N.</au><au>Cetta, Frank</au><au>Stephens, Elizabeth H.</au><au>Aganga, Devon O.</au><au>Van Dorn, Charlotte S.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Adults With Tetralogy of Fallot: Early Postoperative Outcomes and Risk Factors for Complications</atitle><jtitle>Mayo Clinic proceedings</jtitle><date>2021-09</date><risdate>2021</risdate><volume>96</volume><issue>9</issue><spage>2398</spage><epage>2406</epage><pages>2398-2406</pages><issn>0025-6196</issn><eissn>1942-5546</eissn><abstract>To report the early postoperative outcomes in adults with tetralogy of Fallot (TOF) undergoing cardiac surgery and to identify patient factors associated with complications.
We performed a single-institution retrospective review of adults with TOF who underwent cardiac surgery from January 8, 2008, through June 21, 2018. Patients’ characteristics, preoperative imaging, surgical interventions, outcomes, and complications were analyzed.
There were 219 adults with TOF (mean age, 40 years; range, 18-83 years; 88 [40%] female) in the study. Surgical interventions included repair or replacement of the pulmonary valve (n=199 [91%]), tricuspid valve (n=70 [32%]), mitral valve (n=13 [5.9%]), and aortic valve (n=8 [3.7%]). Three patients (1.4%) underwent first-time TOF repair. The 30-day mortality rate was 1.4% (n=3). Early postoperative complications occurred in 66 (30%) and included arrhythmias requiring treatment, dialysis requirement, liver dysfunction, respiratory failure, infection, reoperation, cardiac arrest, mechanical circulatory support, and death. Multivariate analysis found older age at current surgery (odds ratio [OR], 1.04 per year; 95% CI, 1.01 to 1.06; P<.001), longer cardiopulmonary bypass time (OR, 1.01 per minute; 95% CI, 1.01 to 1.02; P<.001), right ventricular systolic dysfunction (OR, 1.31; 95%, CI 1.02 to 1.69; P=.03), diabetes mellitus (OR, 3.50; 95% CI, 1.20 to 10.2; P=.02), and history of initial palliative surgery (OR, 1.99; 95% CI, 1.01 to 3.91; P=.05) as independent predictors of complications.
Surgical interventions for adult patients with TOF can be performed with low early morbidity and mortality. Clinical characteristics and preoperative testing parameters can predict risk for complications in the postoperative period.</abstract><pub>Elsevier Inc</pub><doi>10.1016/j.mayocp.2021.01.032</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0001-8709-6794</orcidid><orcidid>https://orcid.org/0000-0003-3810-8933</orcidid><orcidid>https://orcid.org/0000-0002-2664-1290</orcidid><orcidid>https://orcid.org/0000-0001-8864-8474</orcidid></addata></record> |
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| subjects | Care and treatment Complications Heart Patient outcomes Surgery Tetralogy of Fallot |
| title | Adults With Tetralogy of Fallot: Early Postoperative Outcomes and Risk Factors for Complications |
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