Analysis of the early period results of fallot tetralogy cases which had right ventricule output reconstruction operation by transanular patching method between 2016-2020 at our center

Objective: To examine demographic characteristics, risk factors, preoperative and peroperative findings, and postoperative early follow-up results of Tetralogy of Fallot patients who underwent right ventricular outflow tract reconstruction with transannular patch method in Çukurova University Faculty of Medicine, Department of Pediatric Cardiovascular Surgery between 2016 and 2020, and the relationship of these findings with morbidity and mortality. Materials: The data obtained by examining the echocardiography, angiography, anesthesia-surgery information, intensive care follow-up forms, hospital exit epicrisis from the files of the patients were evaluated. The need for a peroperative transannular patch, type of surgery, cross-clamp time and pump time were examined. Postoperative intubation times, total drainage amount in 24 hours, intensive care and service length of stay, complications and discharge patterns were also recorded from the files and follow-up forms. Method: This study evaluated the early results of 135 patients with Tetralogy of Fallot, who underwent right ventricular outflow tract reconstruction in Çukurova University Faculty of Medicine, Department of Pediatric Cardiovascular Surgery between 2016 and 2020, and relationship of these results with mortality. Results: The ages of our cases ranged from 4 months to 13 years (30.7±28.8 months). 73 of our patients were male and 69 were female. The preoperative hematocrit level of the patients was found to be 46.38±8.5 (32.8-80.5). We had no mortality in 30 patients with preoperative hematocrit 40 or less. Mortality was observed in 6 of our 54 patients whose hematocrit ranged from 40.01 to 47. Mortality was observed in 11 of our 51 patients with hematocrit level above 47. The McGoon ratio was between 1.44 and 3.10. The McGoon ratio was found to be 2.13±0.35 (1.44-3.10) in our patients who survived and 2.16±0.36 (1.56-2.90) in our patients who deceased. The Nakata index ranged between 130 and 458, with an average of 302. The mean Nakata index was found to be 298.9±84.5 (130-458) in our surviving patients, and 323.4±76.5 (168-442) in our deceased patients. The most common accompanying cardiac anomaly was the right aortic arch (15.6%), followed by ASD (9.6%). Cross-clamp time of the patients was 56.2±24.5, total cardiopulmonary bypass time was 93.02±44.4. Monocusp patch was applied to 17 of our patients. No hospital mortality was seen in our patients whom were applied monocusp patch. The mean post-op intensive care unit stay of our patients was 6.4±4.2(1-27) days in surviving patients, and 10.3±10.03(1-38) days in deceased patients. The mean extubation time in surviving patients is 25.3±35.9 hours, with a minimum of 4 hours and a maximum of 202 hours. The mean post-op hospital stay of the surviving patients is 5.01±4.41 days, with a minimum of 1 day and a maximum of 30 days. Complete AV block developed in 2 (1.48%) of our cases, and both of them died. We established ECMO in 18 patients with low cardiac output who had difficulty weaning from peroperative cardiopulmonary bypass (CPB) or who had insufficient postoperative inotropic support. Seven patients (39.9%) in whom ECMO was established were discharged with benefit. The most common accompanying postoperative complication was bleeding (6.68%), followed by pleural effusion (3.7%). 7 (5.18%) of 135 patients who underwent transannular patch were taken into post-op revision operation, and 3 of them deceased. The most common reason for revision was found to be residual VSD. Hospital mortality was found to be 12.6%. Conclusion: Although the early results are satisfactory in TOF patients who underwent total correction by right ventricular outflow tract reconstruction; It was observed that additional cardiac anomalies such as high hematocrit level, additional syndromic diseases, length of CPB duration, low weight and MAPCA increased mortality whether valve protection applied or not. In our findings, it was seen that the Nakata or McGoon index alone did not have a significant effect on mortality. Complete AV block was found to be an important cause of mortality. In addition, it was seen that revision increased hospital mortality. It has been observed that early ECMO application has a mortality-reducing effect in patients who are thought to have sufficient surgical correction and cannot wean from perioperative cardiopulmonary bypass or in whom postoperative inotropic support alone is insufficient. Keywords: Tetralogy of Fallot, Transanular Patch, AV Complete Block, ECMO.