Abstract
Background
Older patients with severe cyanosis from unrepaired tetralogy of Fallot (TOF) face high perioperative morbidity despite technically straightforward surgical repair. Chronic hypoxemia leads to myocardial metabolic adaptation, polycythemia, and increased susceptibility to reperfusion injury. Preoperative optimization may improve outcomes in this high-risk group.
Objective
To evaluate whether palliative balloon pulmonary valvotomy (BPV) before intracardiac repair (ICR) improves immediate postoperative outcomes in severely cyanotic patients with uncomplicated TOF.
Methods
A prospective observational study was conducted on 42 patients (age: 5 months-40 years) with severe cyanosis (oxygen saturation <70%) undergoing BPV followed by elective ICR. Pre and postoperative parameters including oxygen saturation, hemoglobin, hematocrit, ventilation duration, vasoactive inotrope score, intensive care unit (ICU) stay, and hospital stay were recorded. Outcomes were compared with 49 matched controls undergoing direct ICR without BPV.
Results
Balloon pulmonary valvotomy led to a mean saturation increase of 15 ± 3% in 90% of patients, with reported improvement in functional capacity and cessation of cyanotic spells. Compared with the direct ICR group, BPV-ICR patients had significantly shorter ventilation time (13.3 ± 13.8 vs 29.1 ± 37.4 h, P = .011), inotrope duration (46.9 ± 15.5 vs 64.3 ± 30.8 h, P = .001), ICU stay (62.9 ± 36.8 vs 94.9 ± 43.1 h, P < .001), and hospital stay (6.6 ± 3.6 vs 10.6 ± 2.8 days, P = .001). No mortality occurred in the BPV-ICR group versus two deaths in the control group.
Conclusions
Palliative BPV significantly improves preoperative condition and reduces immediate postoperative morbidity in severely cyanotic, anatomically suitable TOF patients. A staged BPV-ICR approach may be a safe, effective strategy in resource-limited settings.
Keywords
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