Early Surgical Outcomes of Tetralogy of Fallot Patients Following Primary Intracardiac Repair at Uganda Heart Institute

Abstract

Abstract Background Tetralogy of Fallot (TOF) is the commonest form of cyanotic congenital heart disease (CHD) worldwide and accounts for 7% of CHD in Uganda. Without surgery, the natural history is nearly always fatal in the long term. Surgery is recommended in infancy to avoid complications of chronic cyanosis and right sided heart failure. In developing countries like Uganda, surgery is usually delayed due several challenges. Objective This study was to determine the early surgical outcomes of TOF patients following primary intracardiac repair at Uganda Heart Institute (UHI) and identify factors associated with these surgical outcomes. Methodology This was a retrospective chart review of primary TOF repair patients at UHI between February 2012 and October 2022. The patient’s outcomes were reviewed from the time of surgery until 30 days in the post operative period. Results A total of 104 patients underwent primary TOF repair at UHI, records of 88 patients (84.6%) were available for review. Males accounted for 48.9% (n=43) of the cases. The median age at the time of operation was 4 years (interquartile range 5.46 years), age range of 9 months to 16years. Children with phenotypic syndromes accounted for 5.7% (n=5), 2 with Down’s and 2 Noonan’s syndromes, followed by 1with Di George syndrome. Early post operative outcomes included residual ventricular septal defects (VSDs) 39.8% (35/88), right ventricular (RV) dysfunction 37.5% (33/88), residual pulmonary regurgitation 30.7% (27/88), residual right ventricular outflow tract obstruction (RVOTO) 30.0% (27/88), pleural effusion 27.3% (24/88), arrhythmias 27.3% (24/88), left ventricular (LV) systolic dysfunction 10.2% (9/88). Overall, 7 children (8%) died in the first 30 days and were all operated on after the age of one year. At multivariate analysis mortality was associated significantly with prolonged mechanical ventilation time post procedure. Conclusion The commonest post operative outcomes were residual ventricular septal defects and RV failure. Our 30-day mortality following TOF repair was 8 %. Prolonged mechanical ventilation time was associated with mortality in this study.