Study Finds Benefits to Both Strategies Used to Treat Symptomatic Tetralogy of Fallot

A multicenter study co-led by the Cardiac Center at Children’s Hospital of Philadelphia (CHOP) has found that each of the two strategies used for treating infants with symptomatic tetralogy of Fallot (sTOF), a congenital heart defect, has potential benefits for patients, depending on several individual factors. The findings were published today in the Journal of the American College of Cardiology.

Most newborns with TOF are asymptomatic, but a subset of patients have symptoms and require early intervention. There are two main approaches for treating these infants: primary repair (PR), in which surgery is performed immediately; and staged repair (SR), in which a surgical or transcatheter procedure is performed to increase pulmonary blood flow, and a complete repair is performed later.

Although some data have suggested a benefit to one procedure over the other, no studies have compared the procedures across multiple institutions in a rigorous way to identify whether one is superior. To assess this, nine centers of the Congenital Cardiac Research Collaborative (CCRC) performed a retrospective cohort study that included all newborns with TOF who underwent initial intervention between January 1, 2005 and November 30, 2017 when they were aged 30 days or younger.

In analyzing the data, the researchers found that early mortality, neonatal morbidity, and procedural complications were lower in the SR group, but cumulative morbidity and the need for additional later interventions were lower in the PR group, suggesting that each strategy has potential benefits.

“These findings support the use of a tailored initial interventional strategy in neonates with symptomatic TOF, considering patient, procedural, and institutional factors,” said Andrew C. Glatz, MD MSCE, an interventional cardiologist in the Cardiac Center at CHOP, one of the four founding members of CCRC, and senior author of the study. “Future research that assesses the impacts of these procedures later in life will likely provide additional insights that will help providers and families choose the optimal management strategy in neonatal sTOF.”

Read more about this study here.