Abstract
Objective: to identify predictors of the right ventricular (RV) dysfunction in toddler patients after tetralogy of Fallot (TF) repair.
Material and methods. In a retrospective comparative study were included 100 patients after TF at the period from 2010 to 2015 years. The first group included 68 patients who had no signs of RV-dysfunction. The second group consisted of 32 patients with proved clinical RV-dysfunction. We analyzed the following parameters: age, weight, presence of concomitant genetic diseases, the development of pulmonary vascular bed (Indices of MсGoon and Nakata), the complexity of the surgery, cardiopulmonary bypass time (CPB), clinical indicators and ultrasound monitoring data.
Results. The duration of cardiopulmonary bypass (CPB) 120 min increases the risk of RV-dysfunction by 1.58 times (p=0.044; OR 1.58; 95% CI 1.19–1.97). Increasing complexity of surgical intervention on a scale of Aristotle comprehensive SCORE each 1 point increases the chances of developing RV-dysfunction by 8% (p=0.0001; OR 1.08; 95% CI 1.01–2.77), as ventriculotomy is by to 3.07 times (p=0.033; OR 3.07; 95% CI 1.13–12.48). As the chance of developing RV-dysfunction increased by 14% (p=0,001; OR 1.14; 95% CI 1.05–1.23) if systolic pressure in the right ventricle is above 40 mm Hg, as lack of the pulmonary and tricuspid valve – to 2.08 times (p=0.021; OR 2.08; 95% CI 1.72–5.98). The concentration of hemoglobin before the operation above 150 g/l also there are such factors at the probability as RV-dysfunction by 14% (p=0.014; OR 1.14; 95% CI 1.01–1.45), and 8% – at hematocrit level 45% above the operation – 8% (p=0.015; OR 1.05; 95% CI 1.01–1.15).
Conclusion. Risk factors for RV-dysfunction after TF repair CPB are more than 120 minutes, the complexity of the surgery by the scale of Aristotle comprehensive SCORE, ventriculotomy, high systolic pressure in the right ventricle, pulmonary valve insufficiency and tricuspid valve insufficiency, policytemia and poliglobulia before surgery.
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