Pr ALI DODGE
KHATAMI
Pitfalls in Early Palliation & Late Repair of Tetralogy and similar Cyanotic Obstructive Lesions
The optimal timing for complete repair of asymptomatic or mildly cyanotic Tetralogy of Fallot patients remains open, but satisfactory results are globally obtained through elective repair between 3-11 months. However, severe Tetralogy of Fallot and similar Cyanotic Obstructive lesions may require treatment at two age extremes of the disease spectrum, namely as deeply cyanotic newborns or as much older children.
For acutely cyanotic newborns, classic palliations including some form of systemic-to-pulmonary artery shunting have been performed since 1944, and yet are still associated with high operative and interstage morbidity & mortality. This had led to looking for alternative palliation strategies with more stable physiology and better outcomes, which are presented.
In older children and adolescents referred late for surgery, many patient, physiology and anatomy-related consequences occur from obstruction to pulmonary blood flow and chronic cyanosis, which considerably increase surgical risk. Awareness of these pitfalls and management strategies to deal with them are suggested, thereby striving to improve outcomes.
Finally, a case should be made towards earlier diagnosis and referral for complete repair between 4-6 months of age, giving excellent results , namely a hospital mortality <1% and a low incidence of residual lesions or need for reoperation.
Ali Dodge-Khatami is Professor & Director of Minimal Invasive Pediatric and Congenital Heart Surgery at the University Clinic RWTH in Aachen, Germany.
He graduated from medical school in Geneva, Switzerland (1991). After cardiac surgery training in Lausanne, Switzerland (CHUV), he did 2 congenital heart surgical fellowships in Chicago (1998-99) at Children’s Memorial Hospital, Northwestern University, and in London, UK (1999-2000) at Great Ormond Street Hospital for Sick Children.
His focus is on primary repair/palliation of complex neonatal defects (arterial switch, truncus arteriosus, interrupted aortic arch and Norwood operations), as well as developing and teaching the minimally invasive cosmetic right axillary approach for the complete repair of the most common congenital heart defects, including ventricular and atrial septal defects, partial anomalous pulmonary veins and partial atrioventricular canal / mitral valve repairs.
Dedicated fully to congenital heart surgery since 2000, with prior academic leadership positions across Europe and North America, he continues to go on yearly humanitarian surgical missions to promote / teach congenital heart surgery in developing regions, including Ukraine, Honduras, Macedonia, Libya, Lebanon, Vietnam, DR Congo, Russian Federation and Kenya.
A Swiss national, he speaks fluent English, French and German, and is proficient in Farsi, Dutch and Spanish.
Cardiovascular Surgery Board Certifications are from Switzerland (FMH 1998), Holland (KNMG 2001) and Germany (DGTHG 2008/2022). He has 2 Ph.D. titles from the University of Amsterdam and the University of Zurich, and is the author of more than 130 peer-reviewed manuscripts / 12 book chapters. He is a proud member of ECHSA, CHSS, AATS, WSPCHS and EACTS.
Passionate hobbies include tennis, powder skiing, scuba diving, and cooking.
