Functional Capacity Is Affected by Younger Age of Repair in Tetralogy of Fallot Patients But Not by Era of Repair

Abstract

Background:

Cardiopulmonary exercise testing is widely used to assess functional capacity in patients with tetralogy of Fallot after surgical repair. Little is known regarding the impact of age at the time of primary complete repair and surgical era effect on exercise capacity.

Methods:

A retrospective, single-center chart review was done from 1976 to 2016 on pediatric patients with tetralogy of Fallot who underwent cardiopulmonary exercise testing with cycle ergometry utilizing the James protocol and were then sorted by repair before/after 1990 and by age of complete repair before/after one year. Exclusion criteria included submaximal tests, incomplete data, previous pulmonary valve replacement, and surgery prior to complete repair (ie, Blalock-Taussig shunt placement).

Results:

When comparing the groups who underwent primary complete repair before (N = 39) and after (N = 26) one year of age, the younger group demonstrated a higher percentage of predicted peak oxygen consumption ( $\dot{V}$ o ₂peak; 83.1% ± 11.8% vs 73.1% ± 16.1%; P = .005) despite having worse pulmonary insufficiency at the time of exercise testing. There were no differences in heart rate and blood pressure response. Age of repair was independently associated with $\dot{V}$ o ₂peak. Data were statistically similar to the study eras (repair before 1990, N = 23; repair after 1990, N = 65): percentage of predicted $\dot{V}$ o₂peak (81.4% ± 13.6% vs 79.1% ± 14.4%, P = .5), maximal systolic blood pressure (155.1 ± 22.4 mm Hg vs 153.9 ± 17 mm Hg, P = .8), and percentage of predicted maximal heart rate (89.8% ± 9% vs 92% ± 7.1%, P = .3).

Conclusions:

Older age at primary repair appears to negatively impact $\dot{V}$ o₂peak; however, era effect does not appear to influence cardiopulmonary exercise testing outcomes.

Keywords

tetralogy of Fallot age of repair era effect cardiopulmonary exercise testing

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References

Bailliard

Anderson

. Tetralogy of Fallot. Orphanet J Rare Dis. 2009;4(2):1–10.

Lillehei

Cohen

Warden

, et al. Direct vision intracardiac surgical correction of the tetralogy of Fallot, pentalogy of Fallot and pulmonary atresia defects; report of first ten cases. Ann Surg. 1955;142(3):418–442.

Starr

. Tetralogy of Fallot: yesterday and today. World J Surg. 2010;34(4):658–668.

Apitz

Webb

Redington

. Tetralogy of Fallot. Lancet. 2009;374(9699):1462–1471.

Friedberg

Fernandes

Roche

, et al. Relation of right ventricular mechanics to exercise tolerance in children after tetralogy of Fallot repair. Am Heart J. 2013;165(4):551–557.

Buys

Van De Bruaene

De Meester

Budts

Vanhees

. Predictors of mid-term event free survival in adults with corrected tetralogy of Fallot. Acta Cardiol. 2012;67(4):415–421.

Muller

Hager

Diller

, et al. Peak oxygen uptake, ventilator efficiency and QRS-duration predict event free survival in patients late after surgical repair of tetralogy of Fallot. Int J Card. 2015;196:158–164.

Mahle

McBride

Paridon

. Exercise performance in tetralogy of Fallot: the impact of primary complete repair in infancy. Pediatr Cardiol. 2002;23(2):224–229.

James

Kaplan

Glueck

Tsay

Knight

MJS

Sarwar

. Responses of normal children and young adults to controlled bicycle exercise. Circulation. 1980;61(5):902–912.

10.

Borg

. Borg’s Perceived Exertion and Pain Scales. Champaign, IL: Human Kinetics; 1998.

11.

Cooper

Weiler-Ravell

Whipp

Wasserman

. Aerobic parameters of exercise as a function of body size during growth in children. J Appl Physiol. 1984;56(3):628–634.

12.

van den Berg

Hop

Strengers

, et al. Clinical condition at mid-to-late follow-up after transatrial-transpulmonary repair of tetralogy of Fallot. J Thorac Cardiovasc Surg. 2007;133(2):470–477.

13.

Yetman

Lee

Hamilton

Morrow

McCrindle

. Exercise capacity after repair of tetralogy of Fallot in infancy. Am J Cardiol. 2001;87(8):1021–1023.

14.

Babu-Narayan

Diller

Gheta

, et al. Clinical outcomes of surgical pulmonary valve replacement after repair of tetralogy of Fallot and potential prognostic value of preoperative cardiopulmonary exercise testing. Circulation. 2014;129(1):18–27.

15.

Dallaire

Wald

Marelli

. The role of cardiopulmonary exercise testing for decision making in patients with repaired tetralogy of Fallot. Pediatr Cardiol. 2017;38(6):1097–1105.

16.

Rabinovitch

Herrera-DeLeon

Castaneda

Reid

. Growth and development of the pulmonary vascular bed in patients with tetralogy of Fallot with or without pulmonary atresia. Circulation. 1981;64(6):1234–1249.

17.

Di Donato

Jonas

Lang

Rome

Mayer

Jr Castaneda

. Neonatal repair of tetralogy of Fallot with and without pulmonary atresia. J Thorac Cardiovasc Surg. 1991;101(1):126–137.

18.

Graham

. Ventricular performance in congenital heart disease. Circulation. 1991;84(6):2259–2274.