Korrektur der Fallotschen Tetralogie nach vorhergehender Palliativoperation- Langzeitergebnisse aus einem historischen Patientenkollektiv

Abstract

Correction tetralogy of Fallot after previous palliative surgery - Long-term results of a historical group of patients Background: tetralogy of fallot is a complex cyanotic heart defect that can be corrected only with the use of cardiopulmonary bypass. Previously there was a palliative surgery. Since 1960 patients are operated with Fallotscher tetralogy in the Department of Thoracic, Heart- and Vascular Surgery in Göttingen. The aim of this study is to analyze the long-term results of a historical group of patients who first treated 1960-1984 with palliative surgery and got the corrective surgery later on. Methods: From 1960 to 1984 324 patients with teralogy of Fallot received correction surgery after previously a palliative surgery was performed. Data analysis was performed retrospectively. Three groups were formed on the basis of primary palliative surgery: BTA Group (Blalock-Taussig shunt, n = 250), WCA Group (Waterstone-Cooley anastomosis, n = 57) and AD group (various other palliative methods, n = 17). Results: The mean patient age for corrective surgery in the BTA group was significantly higher (8.45 ± 4.62 years vs. 6.89 ± 2.96 years in the WCA group; p = 0.0015). The duration of the operation was shorter in the BTA group with 283 ± 105 minutes compared to the WCA group 314 ± 114 minutes (p = 0.32 ). Intraoperative a right intraventricular outflow patch is done 64.5% (BTA: 63.2%, WCA: 70.2%) of these patches were 48.8% transannular (BTA: 44.3%, WCA: 75% ). Rethoracotomy was rare done after corrective surgery in the WCA group (vs. 11% 25% in the BTA group; p = 0.002). The correction operation resulted in all groups in an effective, significant reduction in right ventricular pressure (BTA: from 96.01 ± 21.17 mmHg to 52.75 ± 15.79 mmHg, WCA: from 97.78 ± 34.73 mmHg to 59.05 ± 15.04 mmHg; p <0.001). The duration of mechanical ventilation after the correction operation was in the BTA group significantly shorter than in the WCA group (46 ± 57 hours vs. 108 ± 207 hours; p = 0.002), also the intensive stay in the BTA group was significantly shorter (117 ± 100 hours vs. 189 ± 205 hours in the WCA group; p <0.001). The early mortality in the overall population was 15.1%, there were no significant differences between the groups. In the course 12 more patients died, so that the overall mortality is 18.8%. At the last contact most patients were in NYHA class II and III (NYHA stage of the overall collectivity: 2.3 ± 1.0; BTA group: 2.2 ± 1.0; WCA group: 2.7 ± 0.8). Conclusion: The data analysis shows that BTA represents the more advantageous variant for patients with palliative operation before definitive correction surgery in tetralogy of fallot. During correction surgery patients with prior BTA shunt surgery had a shorter duration of surgery, less bleeding postoperatively, and shorter respiratory and ICU stay. After correction of tetralogy of fallot all patients show an efficient improvement in hemodynamic parameters and a good clinical long-term result. The optimal surgical procedure depends on several factors ( the patient's age, clinical status and anatomical features), it should be done an individual decision and if a palliative surgery is necessary a BTA should be preferred.