Tetralogy of Fallot complete repair: Humanitarian chains versus French native children

BackgroundFrench humanitarian chains promote surgery for children with congenital heart diseases coming from developing countries. We assessed the results following complete repair of tetralogy of Fallot (TOF) in relation to the origin of patients.MethodsA 4-year retrospective review of 73 consecutive patients with TOF repair was performed. Children were divided into two groups: French children (group A, n=38) and children from developing countries (group B, n=35).ResultsPreoperative status differed between the two groups. Children from group B were older (0.82 vs 7.18 year-old, P<0.001), with a lower BMI (16 vs 14kg/m2, P<0.001). They were more symptomatic with lower oxygen saturation (90% vs 83%, P=0.007) combined with a higher level of plasmatic hemoglobin (13.1 vs 16.1g/dL, P<0.001). Proportion of preoperative palliative surgery was higher although not significant in group A (18% vs 6%, P=0.156). There wasn’t any irregular form due to coronary abnormality in the two groups. Preoperative echography showed no difference concerning the rate of pulmonary annulus Z Score<–3 (39% vs 43%, P=0.956). Results of surgery showed no differences in terms of aortic cross-clamping time (65 vs 60min, P=0.235) or rate of trans-annular patch insertion (37% vs 31%, P=0.810). Postoperative course didn’t significantly differ between the two groups. There was no death, two early reoperations (one for bleeding and one for residual VSD) and one late reintervention for residual supra-valvular stenosis in group A after a median follow-up time of 1.8 years. There was one early death (2.8%) and one early reoperation for bleeding in group B after a median follow-up time of 30 days. All were in sinus rhythm.ConclusionElective surgery for TOF repair carries low risk of morbi-mortality. Despite worst preoperative status, children from humanitarian chains can be treated safely by complete repair. Palliative surgery must be reserved for children presenting a marked cachexia profile