Key Factors Influencing Outcomes and ICU Stay After Tetralogy of Fallot Repair

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All articles of this category (opens in new window) Background: Primary repair of tetralogy of Fallot (TOF) typically has low mortality, but postoperative complications persist. This review examines predictors of prolonged ICU stay. Methods: We reviewed all TOF infants who underwent primary surgery from 2003 to 2021 at our institution, focusing on transannular or infundibular patch procedures. Prolonged ICU stay was defined as a length of stay (LOS) of ≥4 days. Results: 197 patients underwent primary surgical repair. Mean age was 4.8 months (95% CI: 1–11 months) and mean weight was 6.02 kg (95% CI: 3.3–8.6 kg). No deaths occurred within 30 postoperative days, but 10 patients needed reintervention in this period. Mean ICU LOS was 5.5 days (95% CI: 2–16 days). Mean intubation time was 43 hours (95% CI: 9–116 hours). 54% of patients had a prolonged ICU stay. Patient’s age and weight did not significantly affect ICU LOS. The surgical technique influenced ICU LOS: ICU LOS in patients with transannular patch was 3 days longer ( p < 0.01) than in patients following infundibular patch. Arrhythmia occurred in 14% of patients. The incidence of arrhythmia was not influenced by the surgical technique ( P = 0.06), but its incidence increased LOS by 5 days. Pleural effusion occurred in 19% of patients; 90% of these patients needed an additional pleural drain. Pleural effusion occurred more frequently with the transannular patch procedure ( p = 0.048), and its incidence increased LOS by 6 days. Table 1 Short (<4 d; 46%) Prolonged (≥4 d; 54%) P -value Age (months, mean) 5.1 (95% CI: 1.3–8.8) 4.6 (95% CI: 2.0–7.1) 0.27 Weight (kg, mean) 6.2 (95% CI: 4.7–7.6) 5.87 (95% CI: 4.7–7.1) 0.08 Surgical technique • Transannular • Infundibular 27 patients64 patients 36 patients (mean 10.7 d)70 patients (mean 7.2 d) <0.01 Arrythmia 0 patients 27 patients Pleural effusion 0 patients 37 patients Conclusion: The mean ICU LOS for patients undergoing TOF repair was 5.5 days. Prolonged LOS (≥4 d) was influenced by the intervention with transannular patch, and the occurrence of arrythmia or pleural effusion. Publication History Article published online: 11 February 2025 © 2025. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

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