Perioperative Factors and Radiographic Brixia Scores’ Effect on Early Extubation After Fallot Tetralogy Surgery

TL;DR

This study finds that older age, valve-preserving surgery, and lower Brixia scores are linked to early extubation after Fallot tetralogy surgery.

Contribution

The study introduces the Brixia score as a reliable tool for predicting early extubation in Fallot tetralogy surgery.

Findings

Older age and valve-preserving surgery are associated with higher early extubation rates.

Lower Brixia scores on ICU admission and postoperative day 1 predict early extubation.

Valve-sparing repair leads to faster lung recovery compared to transannular patch repair.

Abstract

Introduction and Objective: This study aims to evaluate the effect of perioperative factors and radiographic Brixia scores on early extubation following corrective surgery for Fallot tetralogy at a high-volume single cardiac center. Materials and Methods: A retrospective evaluation was conducted on 120 cases who underwent complete correction due to Fallot tetralogy [Median age 6 months (IQR 5–7), Median weight 6.2 kg (IQR 5.2–8 kg)]. Patient demographics, preoperative characteristics, intraoperative variables, postoperative outcomes, surgical type, surgical duration, cardiopulmonary bypass (CPB) time, cross-clamp time, and blood product volumes were retrieved from electronic medical records. P/F ratio, PaO2/FiO2, and Oxygen Index (OI) were calculated. Early extubation was defined as extubation occurring within 6 h after the completion of surgery. The Brixia score (Interstitial opacities, 1 point; interstitial predominant alveolar, 2 points; and interstitial and alveolar opacities, 3 points) was graded for both lung lobes divided into three segments, with a total score ranging from 0 to 18. The results were analyzed statistically. Results: In 60% of the cases (n = 72), valve-preserving surgery was performed, and in 40% (n = 48), a transannular patch was used. The early extubation rate was 20% (n = 24). The median duration of mechanical ventilation was 10 h (IQR, 6–15). Older age (median 8 vs. 5 months), valve-preserving surgery, lower incidence of right-to-left shunt Patent Foramen Ovale (63% vs. 84%), higher P/F ratio on ICU admission (360 vs. 220), and lower Brixia scores on ICU admission (8 vs. 11) and on postoperative day 1 (7 vs. 12) were identified as significant factors for early extubation (p < 0.05). The mortality rate in the entire patient group was 3.3%. In multivariable logistic regression analysis, older age (OR: 1.2, 95% CI: 1.1–1.9 p = 0.03), valve-sparing repair (OR: 1.7, 95% CI: 1.2–2.5, p = 0.008), and lower postoperative Brixia scores (OR:1.4 95% CI: 1.2–2.1, p = 0.02) remained independently associated with early extubation. Conclusions: The Brixia score can be used as a reliable scoring system for evaluating postoperative lung status. Pulmonary valve-preserving repair shows a profile of earlier lung parenchyma recovery compared to transannular patch repair.