CÁC YẾU TỐ NGUY CƠ TIÊN LƯỢNG TỬ VONG VÀ MỔ LẠI SAU PHẪU THUẬT SỬA CHỮA TRIỆT ĐỂ TỨ CHỨNG FALLOT TẠI BỆNH VIỆN NHI TRUNG ƯƠNG

Abstract

Objective: This study was conducted to evaluate, analyze and discover the risk factors for mortality and reoperation in the follow-up of patients who underwent total correction of tetralogy of Fallot at Heart Center-National Children’s Hospital, Hanoi, Vietnam. Methods: From 2006 to 2020, patients who underwent total correction at our institution were collected for this study. Multivariate logistic regression analysis was performed to evaluate the risks factor of mortality and reoperation for the patients who died in the hospital or late death, and for patients who required reoperation during follow-up. Results: A total of 532 patients was collected in this study, in which 399 patients (75%) have pulmonary valve preservation. There were 11 patients (2.1%) who died in hospital, and 2 late death (0.4%). Twelve patients required reoperation during a follow-up time of 40.4 ± 26.27 months. Multivariate logistic regression analysis revealed that the prolonger postoperative ventilation time was a risk factor for mortality (OR=1.04; p=0.001). The patients with postoperative pressure gradient through the right ventricular outflow tract > 50mmHg was a risk factor for reoperation (OR=108; p=0.001). Patients who underwent pulmonary valve-sparing have a significantly lower moderate to severe pulmonary valve regurgitation (p=0.0001) and also hypertrophy of the right ventricle (p=0.023) compared with patients who required a transannular patch. Conclusions: Earlyextubation could reduce mortality after total correction of tetralogy of Fallot. Patients who have a postoperative pressure gradient over 50mmHg may get the benefit of reducing reoperation in the future by a secondary aortic cross-clamping at the time of total correction.