Hemodynamic Results After Intracardiac Repair of Tetralogy of Fallot by Deep Hypothermia and Cardiopulmonary Bypass

MURPHY, JOHN D. M.D.
FREED, MICHAEL D. M.D.
KEANE, JOHN F. M.D.
NORWOOD, WILLIAM I. M.D.
CASTANEDA, ALDO R. M.D.
NADAS, ALEXANDER S. M.D.

Departments of Cardiology and Cardiovascular Surgery, Children's Hospital Medical Center, and the Departments of Pediatrics and Surgery, Harvard Medical School, Boston, Massachusetts.

Address for correspondance: John D. Murphy, M.D., Department of Cardiology, Children's Hospital Medical Center, 300 Longwood Avenue, Boston, Massachusetts 02115.

Supported in part by USPHS grant HL-07193-02.

Circulation 62:p I168-I174, August 1980.

SUMMARY

To evaluate our policy of primary repair of tetralogy of Fallot, we analyzed the results of corrective surgery in all 208 children operated upon between January 1973 and June 1977. Of these, 40 were symptomatic, cyanotic infants, ages 16 days to 15 months (median 6 months), repaired under deep hypothermic circulatory arrest (DH); 168 patients, ages 3 months to 36 years (median 6 years), were repaired on cardiopulmonary bypass (CPB). Among the patients repaired on CPB, 97 (58%) had undergone a palliative shunt. The operative mortality was 10% (four of 40) in the DH group and 5% (eight of 168) in the CPB group (p = 0.35). Of the survivors, 84% (30 of 36) of the DH group and 65% (104 of 160) of the CPB group were recatheterized 2 days to 4 years (median 13 months) after surgery.

Hemodynamically significant ventricular septal defects (Qp/Qs 2 1.5) were present in 3% (one of 30) of the DH group, compared with 17% (18 of 104) of the CPB group (p = 0.05).

Residual pulmonic stenosis with a right ventricular-to-pulmonary artery gradient 2 40 mm Hg was present in 10% (three of 30) of the DH group and 24% (25 of 104) of the CPB group (p = 0.09)

Surgical repair of infants under DH is associated with late hemodynamic results equal to or better than those with CPB and continues to be our operation of choice in symptomatic infants with tetralogy of Fallot.