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

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