An audit of surgical repair of Tetralogy of Fallot in an African tertiary care centre

Background: For patients undergoing Tetralogy of Fallot (TOF) repair at institutions in sub-Saharan Africa, data on type of surgical repair, operative mortality and important determinants of outcome such as age at operation and development of pulmonary regurgitation (PR) post-repair is scanty. Objec...

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Autores principales:	Deliwe P. Ngwezi, Katharina Vanderdonck, Solomon E. Levin, Antoinette Cilliers
Formato:	article
Lenguaje:	EN
Publicado:	South African Heart Association 2017
Materias:	tetralogy of fallot (tof) sub-saharan africa Diseases of the circulatory (Cardiovascular) system RC666-701
Acceso en línea:	https://doaj.org/article/76d4f1a1b136481184382705c5042b55
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spelling	oai:doaj.org-article:76d4f1a1b136481184382705c5042b552021-11-29T13:46:48ZAn audit of surgical repair of Tetralogy of Fallot in an African tertiary care centre10.24170/10-3-17921996-67412071-4602https://doaj.org/article/76d4f1a1b136481184382705c5042b552017-03-01T00:00:00Zhttps://www.journals.ac.za/index.php/SAHJ/article/view/1792https://doaj.org/toc/1996-6741https://doaj.org/toc/2071-4602Background: For patients undergoing Tetralogy of Fallot (TOF) repair at institutions in sub-Saharan Africa, data on type of surgical repair, operative mortality and important determinants of outcome such as age at operation and development of pulmonary regurgitation (PR) post-repair is scanty. Objective: To describe the outcomes of children diagnosed with TOF who underwent surgical repair at our center with emphasis on post-operative PR. Methods: This was a retrospective cohort study undertaken from 1 January 1994 to 31 December 2003 at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH). The descriptive analysis of the clinical audit was done in 2010. Results: Fifty four (75%) patients were operated upon: 50 (92.5%) had complete repair and 4 (7.4%) had a palliative procedure in the form of a Blalock-Taussig (B-T) shunt. The median age for corrective surgery was 39.5 months. Twenty out of 50 (40%) patients had simple repair, 10 (20%)had repair which included pulmonary valvotomy, 15 (30%) had a transannular patch (TAP) repair with or without monocusp and 5 (10%) had conduit insertion. An evaluation of severe PR among all the repair groups in the immediate post-operative period (<1 year) revealed that 5 out of 15 (33.3%) patients who had TAP repair developed severe PR, whilst no severe PR was noted in the simple, pulmonary valvotomy and conduit repair groups. During the intermediate post-operative period (1 - 5 years), severe PR was documented in 4 (27%) patients with TAP repair, 2 (10%) with simple repair and 2 (20%) in the pulmonary valvotomy group only. In the long term period (>5 years), severe PR was documented in 3 (30%) patients with pulmonary valvotomy, 8 (53%) who had TAP repair, 2 (10%) patients with simple repair including 1 (20%) patient with a xenograft conduit. One out of 50 (2%) surgically corrected patients who had a complex anatomy died in the immediate post-operative period. Twenty eight out of 50 (56%) patients who had complete correction were lost to follow-up. Conclusion: Surgical correction occurs much later in infancy and childhood compared to developed countries. Severe PR is a serious complication strongly associated with all types of surgical repair of TOF and these patients require lifelong follow-up. Despite the small sample size, the operative mortality compares favourably to first world centers.Deliwe P. NgweziKatharina VanderdonckSolomon E. LevinAntoinette CilliersSouth African Heart Associationarticletetralogy of fallot (tof)sub-saharan africaDiseases of the circulatory (Cardiovascular) systemRC666-701ENSA Heart Journal, Vol 10, Iss 3, Pp 520-525 (2017)
institution	DOAJ
collection	DOAJ
language	EN
topic	tetralogy of fallot (tof) sub-saharan africa Diseases of the circulatory (Cardiovascular) system RC666-701
spellingShingle	tetralogy of fallot (tof) sub-saharan africa Diseases of the circulatory (Cardiovascular) system RC666-701 Deliwe P. Ngwezi Katharina Vanderdonck Solomon E. Levin Antoinette Cilliers An audit of surgical repair of Tetralogy of Fallot in an African tertiary care centre
description	Background: For patients undergoing Tetralogy of Fallot (TOF) repair at institutions in sub-Saharan Africa, data on type of surgical repair, operative mortality and important determinants of outcome such as age at operation and development of pulmonary regurgitation (PR) post-repair is scanty. Objective: To describe the outcomes of children diagnosed with TOF who underwent surgical repair at our center with emphasis on post-operative PR. Methods: This was a retrospective cohort study undertaken from 1 January 1994 to 31 December 2003 at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH). The descriptive analysis of the clinical audit was done in 2010. Results: Fifty four (75%) patients were operated upon: 50 (92.5%) had complete repair and 4 (7.4%) had a palliative procedure in the form of a Blalock-Taussig (B-T) shunt. The median age for corrective surgery was 39.5 months. Twenty out of 50 (40%) patients had simple repair, 10 (20%)had repair which included pulmonary valvotomy, 15 (30%) had a transannular patch (TAP) repair with or without monocusp and 5 (10%) had conduit insertion. An evaluation of severe PR among all the repair groups in the immediate post-operative period (<1 year) revealed that 5 out of 15 (33.3%) patients who had TAP repair developed severe PR, whilst no severe PR was noted in the simple, pulmonary valvotomy and conduit repair groups. During the intermediate post-operative period (1 - 5 years), severe PR was documented in 4 (27%) patients with TAP repair, 2 (10%) with simple repair and 2 (20%) in the pulmonary valvotomy group only. In the long term period (>5 years), severe PR was documented in 3 (30%) patients with pulmonary valvotomy, 8 (53%) who had TAP repair, 2 (10%) patients with simple repair including 1 (20%) patient with a xenograft conduit. One out of 50 (2%) surgically corrected patients who had a complex anatomy died in the immediate post-operative period. Twenty eight out of 50 (56%) patients who had complete correction were lost to follow-up. Conclusion: Surgical correction occurs much later in infancy and childhood compared to developed countries. Severe PR is a serious complication strongly associated with all types of surgical repair of TOF and these patients require lifelong follow-up. Despite the small sample size, the operative mortality compares favourably to first world centers.
format	article
author	Deliwe P. Ngwezi Katharina Vanderdonck Solomon E. Levin Antoinette Cilliers
author_facet	Deliwe P. Ngwezi Katharina Vanderdonck Solomon E. Levin Antoinette Cilliers
author_sort	Deliwe P. Ngwezi
title	An audit of surgical repair of Tetralogy of Fallot in an African tertiary care centre
title_short	An audit of surgical repair of Tetralogy of Fallot in an African tertiary care centre
title_full	An audit of surgical repair of Tetralogy of Fallot in an African tertiary care centre
title_fullStr	An audit of surgical repair of Tetralogy of Fallot in an African tertiary care centre
title_full_unstemmed	An audit of surgical repair of Tetralogy of Fallot in an African tertiary care centre
title_sort	audit of surgical repair of tetralogy of fallot in an african tertiary care centre
publisher	South African Heart Association
publishDate	2017
url	https://doaj.org/article/76d4f1a1b136481184382705c5042b55
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An audit of surgical repair of Tetralogy of Fallot in an African tertiary care centre

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