Symptomatic Tetralogy of Fallot in Young Infants: Primary Repair or Shunt—Pediatric Health Information System Database Analysis

Karthik V. Ramakrishnan, David Zurakowski, William Pastor, Richard A. Jonas, Pranava Sinha

Research output: Contribution to journalArticlepeer-review

18 Scopus citations


Background: Compare the early outcomes and hospital charges of early primary repair and systemic-to-pulmonary artery shunt for neonates and young infants (≤90 days of age) with tetralogy of Fallot using data from the Pediatric Health Information System database. Methods: The Pediatric Health Information System database was queried for patients <90 days of age with primary diagnosis of tetralogy of Fallot who underwent nonelective surgical repair or palliation between January 2008 and December 2014. The initial cohort of 821 patients (group 1 early primary repair, N = 554; group 2 systemic-to-pulmonary artery shunt, N = 267) was propensity score matched (248 patients in each group) to account for baseline imbalances in age and prostaglandin use. Results: Comparison of unmatched groups revealed younger age and higher incidence of extracardiac anomalies (P =.02) and prematurity (P =.04) in group 2. Mortality was comparable between the groups (group 1: 20 [4%] of 554 vs group 2: 11 [4%] of 267, P =.74). Irrespective of the type of procedure, prematurity (odds ratio [OR] = 3.3, 95% confidence interval [CI]: 1.5-7.4) and extracardiac anomalies (OR = 2.5, 95% CI: 1.2-5.3) were independent risk factors for mortality. Propensity score–matched analysis revealed no significant differences in patient mortality (P = 1), duration of ventilation (P =.64), hospital length of stay (P =.69), or hospital charges (P =.08) between the two groups. Conclusion: Outcomes and hospital charges associated with nonelective early primary repair are comparable to systemic-to-pulmonary artery shunt in symptomatic patients <90 days old with tetralogy of Fallot.

Original languageEnglish (US)
Pages (from-to)539-545
Number of pages7
JournalWorld Journal for Pediatric and Congenital Heart Surgery
Issue number5
StatePublished - Sep 1 2018
Externally publishedYes

Bibliographical note

Publisher Copyright:
© The Author(s) 2018.


  • congenital heart disease
  • congenital heart surgery
  • cost analysis
  • shunts(systemic to pulmonary artery)


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