Related Experiment Video
Updated: Nov 9, 2025
A Rodent Model of The Ross Operation: Syngeneic Pulmonary Artery Graft Implantation in A Systemic Position
Published on: April 1, 2022
What is the optimal age for repair of tetralogy of Fallot?
G S Van Arsdell1, G S Maharaj, J Tom
1Division of Cardiac Surgery and Cardiology, The Hospital for Sick Children, Toronto, University of Toronto, Toronto, Canada. glen.vanarsdell@sickkids.on.ca
Insights
The optimal age for tetralogy of Fallot repair is 3 to 11 months. Early repair in this age group, compared to older infants, shows improved survival and physiological outcomes, avoiding palliative shunts.
Area of Science:
- Pediatric Cardiac Surgery
- Congenital Heart Disease
- Surgical Outcomes Research
Background:
- The optimal timing for surgical repair of tetralogy of Fallot (TOF) is debated, particularly for symptomatic neonates versus asymptomatic infants.
- Historically, initial palliation was favored for infants, with later repair for asymptomatic children.
Purpose of the Study:
- To evaluate the impact of a protocol change from initial palliation to primary repair around 6 months of age for tetralogy of Fallot.
- To determine the optimal age for repair based on mortality and physiological outcomes.
Main Methods:
- Retrospective review of 227 consecutive patients undergoing isolated tetralogy of Fallot repair between January 1993 and June 1998.
- Analysis of changes in median repair age, use of palliative shunts, mortality rates, and physiological outcomes (lactate clearance, ventilation hours, length of stay).
Main Results:
- Median age of repair decreased significantly from 17 to 8 months, with a reduction in palliative shunts from 38% to 0%.
- Overall mortality improved (2.6% to 0% post-protocol change), with no deaths since late 1995/early 1996.
- Primary repair before 3 months was associated with prolonged recovery times; deaths occurred in repairs performed after 12 months.
Conclusions:
- The optimal age for elective tetralogy of Fallot repair is between 3 and 11 months.
- Primary repair within this age window yields the best survival and physiological outcomes.
- This age range balances surgical risk and physiological benefits, avoiding both early palliative procedures and delayed repair.
Background:
Controversy regarding the timing for the repair of tetralogy of Fallot centers around initial palliation versus primary repair for the symptomatic neonate/young infant and the optimal age for repair of the asymptomatic child. We changed our approach from one of initial palliation in the infant to one of primary repair around the age of 6 months, or earlier if clinically indicated. We examined the effects of this change in protocol and age on outcomes.
Methods And Results:
The records of 227 consecutive children who had repair of isolated tetralogy of Fallot from January 1993 to June 1998 were reviewed. The median age of repair by year fell from 17 to 8 months (P:<0.01). The presence of a palliative shunt at the time of repair decreased from 38% to 0% (P:<0.01). Mortality (6 deaths, 2. 6%) improved with time (P:=0.02), with no mortality since the change in protocol (late 1995/early 1996). Multivariate analysis for physiological outcomes of time to lactate clearance, ventilation hours, and length of stay, but not death, demonstrated that an age <3 months was independently associated with prolongation of times (P:<0.03). Each of the deaths occurred with primary repair at an age >12 months. The best survival and physiological outcomes were achieved with primary repair in children aged 3 to 11 months.
Conclusions:
On the basis of mortality and physiological outcomes, the optimal age for elective repair of tetralogy of Fallot is 3 to 11 months of age.
Related Concept Videos
01:26Mitral Stenosis III: Medical Management
01:27Development of the Heart
As the embryo undergoes lateral folding, these paired tubes approach each other, merging into a single primitive heart...