Surgery for XXXX at less than six months of age. Is palliation "old-fashioned"?

@entity1 @entity215 @entity204
There is still no consensus regarding the most appropriate protocol for managing symptomatic @entity1 with @entity215 ( @entity215 ) presenting during early infancy. From January 1987 to April 1994, 83 @entity1 with @entity215 were operated on at less than 6 months of age. Sixty @entity1 (mean age 109 +/- 5 days) underwent primary repair and 23 (mean age 72 +/- 10 days) underwent initial palliation with a modified Blalock-Taussig shunt (MBTS) in 22 cases. No strict protocol was used but @entity1 who received initial palliation had lower weight, smaller pulmonary annulus or had an anomalous coronary artery. Nineteen of the @entity1 initially palliated underwent repair at a median of 13 months after palliation. During this interval, the pulmonary annulus size increased from a Z-value of -3.0 +/- 0.4 at palliation to -1.6 +/- 0.7 at repair (P = 0.06) and the summed diameters of pulmonary artery branches from -2.2 +/- 0.4 to -1.6 +/- 0.7 (P = 0.2). There were no operative @entity204 among the repaired @entity1 , but two @entity1 died early after shunt insertion. Transannular patch was required in 58% of the @entity1 regardless of the management protocol. Actuarial survival rate and freedom from reoperation at 48 months were 98.0% and 77.4% (P = 0.003) and 87.6% and 90.0% in primarily repaired and initially palliated @entity1 , respectively. Primary repair of @entity215 at the time of presentation is the preferred approach regardless of age.(ABSTRACT TRUNCATED AT 250 WORDS)
