Clinical outcomes of tetralogy of Fallot with restrictive right ventricle physiology after repair

Abstract

Objective To evaluate the risk factors, diagnostic index of the restrictive right ventricle physiology(rRV) and the impact of the mid-term outcome of the patients. Methods Eighty patients(30 in rRV group and 50 in non-rRV group) undergoing TOF repair admitted in our department from Oct 2011 to May 2012 were studied.Perioperative clinical data were collected and echo data were recorded after operation.Mixed linear regression for repeated measures was used to compare the variables and analyze the correlations. Results Patients in rRV group were younger with longer cardiopulmonary bypass(CPB) time, aortic cross clamp time, ventilation time, intensive care unit and hospital stay compared with those in non-rRV group(P<0.01, respectively). The younger patients with longer CPB time had high risk of rRV by logistic regression analysis.Within 7 days post operation, the increase of saturation of venous oxygenation and decrease of oxygen extraction ration were slower in rRV group than those in non-rRV group(P<0.05, respectively). Lactate decreased in both groups, but was higher in rRV group throughout the 7 days(P=0.03). NT-proBNP was higher in rRV group throughout the 7 days than that in non-rRV group.NT-proBNP≥4 750 pg/ml often indicated the patients in the state of rRV.CRP slightly increased in 1-2 days post operation, and decreased thereafter, and the decrease was slower in rRV group(P=0.08). With regard to the mid-term outcome, there was no significant differences in the incidences of the obstruction of the right ventricle outflow and main pulmonary artery, the stenosis of the branch of pulmonary artery and the degree of the pulmonary valve regurgitation. Conclusion rRV is associated with significantly higher levels of NT-proBNP and CRP.The incidence of rRV correlates with age on operation and positively correlates with CPB time.NT-proBNP would be regarded as an indicator of the incidence of rRV.The study indicated the rRV would have impact on the early outcome of the patients but there was no significant effect on mid-term outcome. Key words: Tetralogy of Fallot; Restrictive right ventricle physiology; N-terminal pro-BNP; Mid-term follow-up,