چکیده (انگلیسی):

Objective: Right ventricular (RV) dysfunction is a significant cause of morbidity
and mortality after surgical correction of tetralogy of Fallot (TOF). Transatrial/transpulmonary
repair avoids a ventriculotomy (in contrast to the transventricular approach) in order to preserve
the structure and function of the right ventricle. We performed a pilot prospective randomized
controlled trial in infants with TOF undergoing primary repair.
Methods: A pilot prospective controlled clinical trial was conducted in infants with TOF undergoing
primary repair between January 2008 and December 2009. One hundred and six patients were recruited
in the trial and divided into a transatrialetranspulmonary approach group (Group A;
n Z 53) and a transventricular approach group (Group B; n Z 53), depending on the different surgical
techniques used.
Results: Preoperative patient characteristics and procedure-related variables were similar. There
were no deaths in Group A, while two patients died in Group B. There were significant differences
in cardiopulmonary bypass time (95.02
23.8 vs. 85.23
22.63 minutes, p Z 0.032),
cross-clamp time (69.4
10.36 vs. 61.17
9.38 minutes, p Z 0.035), inotropic support
(1.63
0.97 vs. 2.1
1.09 days, p Z 0.02), intubation time (26.62
12.48 vs. 33.02
17.55
hours, p Z 0.033), duration of stay in the intensive care unit (ICU) (2.25
1.28 vs.
2.85
1.46 days, p Z 0.026), and the incidence of arrhythmia [3 patients (5.7%) vs. 10 patients
(18.9%), p Z 0.038]. No significant differences in right/left ventricular pressure ratio and hospital
stay were observed.
Conclusion: Transatrial/transpulmonary repair of TOF is associated with excellent surgical results
and immediately follow-up.