Abstract
Contemporary surgical practice relating to Tetralogy of Fallot is shifting towards earlier correction; however, a recent large study proposes later correction to increase event free survival. Surgery aims to improve the quantity and quality of life at minimal risk to the patient. Surgical outcome and risk assessment requires a comparison of externally valid studies of natural history and surgical outcome. The authors reviewed the literature to identify the most externally valid natural history and surgical outcome data and used it to develop a composite survival graph to help clinicians determine when surgery would offer the greatest survival advantage. The composite graph suggests that, for symptomatic patients, the greatest survival advantage occurs when corrective surgery is performed within the 1st week of life. Key words: Pediatric, tetralogy of Fallot, operative, outcomes.
Highlights
Tetralogy of Fallot (ToF) is a congenital heart malformation characterised by obstruction of the right ventricular out flow tract, a ventricular septal defect, overriding aorta and ventricular hypertrophy; total surgical correction is the gold standard of treatment
Outcome: the authors are concerned that the surgical outcome in relation to the age at surgery was discussed without providing a natural history context
Full text references for surgical outcome were excluded if they did not follow-up a sufficient number of patients for 15 years to yield a power of 80%; or if this could not be determined from the data in the full text
Summary
Tetralogy of Fallot (ToF) is a congenital heart malformation characterised by obstruction of the right ventricular out flow tract, a ventricular septal defect, overriding aorta and ventricular hypertrophy; total surgical correction is the gold standard of treatment. AAS= age at surgery; LSS=large sample size; NH=natural history; SO=surgical outcome; ToF=Tetralogy of Fallot. After examining the natural history studies retrieved; it was concluded that the most externally valid study followed up patients for 15 years.
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