Supervisors info:
Τούσουλης Δημήτριος, Καθηγητής, Ιατρική, ΕΚΠΑ
Κυρίτση Ελένη, Ομότιμη Καθηγήτρια, Νοσηλευτική, Πανεπιστήμιο Δυτικής Αττικής
Τούτουζας Κωνσταντίνος, Αναπληρωτής Καθηγητής, Ιατρική, ΕΚΠΑ
Summary:
Introduction: Tetralogy of Fallot is the most common form of cyanotic congenital heart disease. Significant advances in surgery techniques have prolonged patient survival and improved the quality of life. Though, the appearance of life-threatening complications is an integral part of surgical treatment.
Purpose: Main aim was a critical evaluation of literature in order to illustrate potential postoperative complications in patients who had undergone TOF repair.
Material-Methods: A Retrospective study of 100 patients aged 0-16 years old who have undergone tof repair or palliative surgery from 01.01.2008 until 31.12.2017. Data were collected via special form conducted by the researchers of the study. The statistical analysis was performed using SPSS statistic package for Windows (version 20.0). The level of significance was estimated p-value<0,005. Multivariable analysis and logistic regression were
used.
Results: The study group consisted of a hundred children (fifty boys, fifty girls) undergone TOF repair, with mean age 2.81 (±3.85). The mean length of stay in ICU was 7.2±5.5 days, while the mean length of stay at the hospital was 16.5±15.9 days, correspondingly. The majority of the patients (80%) underwent TOF repair. The mean operation time was 204.3 minutes approximately while 47 patients experienced intra-operative complications. The most common intra-operative complication was cardiac arrhythmia (n=28), followed by intra-operative bleeding (n=10) and hemorrhagic disorders (n=3). Post-operatively, the 77% of the patients were hemodynamically stable. During the post operative period, the majority of the patients needed inotropic support. The most common post-operative complication observed was thrombocytopenia (n=31), followed by low cardiac output syndrome (n=14) and post-operative bleeding (n=12). Overall, half of the patients (50%) experienced post-operative arrhythmias. The most common post-operative arrhythmia was junctional ectopic tachycardia (n=15), followed by juctional rhythm (n=14) and AV block (n=10). Post-operative arrhythmias were not associated with the gender, the age, the weight, the RACHS scale, the propranolol, and the CPB time. Post-operative bleeding was not statistically associated with patients’ gender, age and weight. Post-operative cardiac support was strongly associated with post-operative bleeding (p-value=0,001) while patients experienced post-operative bleeding had statistically significant prolong length of stay in icu (p-value=0,047). Patients with thrombocytopenia had a 7.7 fold of greater odds of having nosocomial infections comparably with the rest of the patients (p-value=0,003). Patients experienced post operative pleural effusion had statistically significant higher CPB time (pvalue=0.015), length of stay in icu (pvalue<0,001) and intubation time (p<0,001) comparably with the rest of the patients.
Conclusions: Health care professionals caring for postoperative patients with TOF must have a unique understanding of complications in order to provide an efficient individualized care plan.
Keywords:
Τetralogy of fallot, Congenital heart disease, Postoperative complications, Intensive care management
