Right Ventricle Diastolic Dysfunction in Tetralogy of Fallot Patients Affecting Surgical Outcome

Objective: To compare the surgical outcome of Tetralogy of Fallot patients with and without right ventricular diastolic dysfunction after repair. Study Design: Quasi-experimental study. Place and Duration of Study: Department of Cardiology, National Institute of Cardiovascular Disease, Karachi Pakistan, from May to Oct 2021. Methodology: Patients above 5 months of age, of either gender, undergoing surgery for Tetralogy of Fallot were enrolled. Patients were divided into two groups according to the Gatzoulis’ criterion for right ventricular restriction i.e. Group-A had right ventricle with restriction, and Group-B had right ventricle without restriction. Velocities of E and A waves was recorded, and their ratio (E/A) was calculated. The outcome such as aortic cross clamp, cardiopulmonary bypass time, ventilation time, intensive care unit stay, drain time, and transannular patch was noted. Results: Of 54 patients, restrictive physiology patients had significantly higher mean for aortic cross-clamp (p-value 0.004, 95%CI 3.54 - 17.35), ventilation time (p-value<0.001, 95% CI 20.03-31.22), intensive care unit stay (p-value 0.014, 95% CI 0.19 - 1.65), drain time (p-value<0.001, 95% CI 105.29 - 31.21), and duration of inotropes (p-value<0.001, 95% CI 29.09 - 51.79). Moreover, transannular patch was significantly higher among patients with restrictive physiology as compared to the patients without non-restrictive physiology, i.e., 23(85.2%) vs. 8(29.6%) (p-value<0.001). Conclusion: A considerable difference was observed in the surgical outcome of Tetralogy of Fallot patients with and without right ventricular diastolic dysfunction after repair.