Postoperative mechanical ventilation after corrective Tetralogy of Fallot surgery in infants: Assessment of perioperative factors and radiographic severity scores

Early recovery from surgery for congenital heart disease (CHD) is becoming a trend. Tetralogy of Fallot/pulmonary stenosis (TOF/PS) is the most common cyanotic CHD with excellent long-term outcomes. We examined potential factors associated with early extubation in 249 patients who underwent TOF/PS complete repair in a tertiary pediatric medical center from January 2015 to December 2022. Patient demographics, preoperative characteristics, intraoperative variables, postoperative outcomes, surgical type, surgical duration, cardiopulmonary bypass (CPB) time, cross-clamp time, and blood product volumes were acquired from the electronic medical records. Valve sparing repair (VSR) tends to demonstrate earlier recovery profiles than transannular patch repair (TAP) irrelevant of the presence of monocusp valve (P < 0.0001) and the degree of right ventricular outflow pressure drop was significantly correlated with post-operative recovery profile (p = 0.0204). Because of intracardiac shunts and PaO₂/FiO₂ ratios being poor indicators of lung injury, Brixia scores were also used. Our data suggested that Brixia score could be an excellent alternative to evaluate post-operative lung status.