Tetralogy of Fallot: influence of surgical technique on survival and reoperation rate

The influence of different surgical techniques in patients with Tetralogy of Fallot (TOF) on long-term survival and reoperation rate is still a matter of controversy.

The data of 266 patients (152 male, 114 female, mean body weight: 13.4 +/- 11.9 kg, mean age 4.1 +/- 6.0 years) with TOF, including 30 patients (11.2 %) with TOF/pulmonary atresia, were analyzed retrospectively. A palliative surgical procedure preceded definite correction between 1975 and 1999 in 46 patients (17.5 %). The surgical technique consisted of a transannular patch in 103 patients (40.1 %); in 133 patients (51.8 %), a non-transvalvular technique was used. In 33 patients (12.3 %), a conduit was implanted into the right ventricular outflow tract (RVOT). For surgical access to the cardiac defects, a transventricular approach was used in 138 patients, and a transatrial/trans-pulmonary approach in 26 patients. The mean follow-up time of all patients was 6.6 years.

Kaplan-Meier survival for the entire group was 86.2 % at one year and remained stable at 85.6 % after 5 years. The 30-day mortality was 10.1 % (27 patients). Fatal risk factors were: previous cardiac surgery, preoperative oxygen saturation (SO(2)) < 80 %, diagnosis of pulmonary atresia, prolonged aortic clamping or bypass time, postoperative infections, and early revisions. Freedom from reoperation was 91.6 % after 5, 84.5 % after 10, and 52.6 % after 20 years. There was no correlation between the different surgical techniques (transannular patch, non-transvalvular techniques, transventricular approach) applied and the mortality or the rate of reoperations.

In our series of TOF patients operated over a period of 25 years, we were unable to assess an influence of the surgical technique used for definite correction on mortality or reoperation rate. Pulmonary atresia in patients with TOF is associated with a higher risk of death and reoperation.