Abstract 18747: Young Infants With Severe Tetralogy of Fallot: Early Primary Surgery versus Trans-catheter Palliation

Abstract

Introduction: Infants with severe tetralogy of Fallot (TOF) may undergo: 1) early primary surgical repair (EARLY) or 2) early catheter palliation (CATH) prior to delayed surgical repair. We compared these two strategies to 3) usual elective single stage TOF repair (USUAL). Methods: We studied 453 TOF repairs (2000-2012, excluding BT shunts). USUAL strategy at our institution is repair ≥3 months. Risk adjusted hazard analysis compared freedom from surgical or catheter reintervention. Somatic size, branch PA size and RV systolic pressure were modeled using 2543 echo reports via mixed model regression. Results: Table: group characteristics for USUAL (383), EARLY (42) and CATH (28). CATH involved: RVOT stent=18, RVOT balloon=9, ductal stent=1. Risk adjusted freedom from surgical reoperation was 88%, 87% and 85% for USUAL, EARLY and CATH respectively, at 10 years. EARLY and CATH had similar reoperation rates, except for very young children (<1 month) where EARLY primary repair conferred increased risk of further surgery (Figure). Risk adjusted freedom from catheter reintervention was higher for EARLY (76%) and especially so for CATH (53%) at 10 years, versus USUAL (83%; Figure). Somatic growth and progression of RVSP (37-40mmHg) was similar among groups at 8 years. EARLY (P=.02) and CATH (P=.09) tend to have smaller bPAs initially. The CATH group tend to remain smaller in the long-term, whereas growth in EARLY matches USUAL. Conclusions: Early primary repair at very young ages comes with a cost of increased late surgical reoperation. Early transcatheter palliation tends to come with a cost of increased late transcatheter intervention - possibly related to slower branch PA growth.