Exercise performance in tetralogy of Fallot: the impact of primary complete repair in infancy
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Published on: January 27, 2023
W T Mahle1, M G McBride, S M Paridon
1The Children's Hospital of Philadelphia, and Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
Insights
Primary complete repair (PCR) for tetralogy of Fallot (TOF) in infancy does not affect long-term exercise performance. Children who had PCR in the first year of life showed similar exercise capacity to those repaired later.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease
- Exercise Physiology
Background:
- Primary complete repair (PCR) for tetralogy of Fallot (TOF) is standard in infants.
- While surgical outcomes are good, the long-term effects on exercise capacity are not fully understood.
Purpose of the Study:
- To evaluate the impact of age at primary complete repair (PCR) on the intermediate-term exercise performance in children with tetralogy of Fallot (TOF).
Main Methods:
- Retrospective review of 193 patients with TOF who underwent PCR between 1995 and 2000.
- Maximal cycle ergometer exercise testing was performed on 50 patients.
- Exercise data was analyzed comparing those repaired before versus after one year of age.
Main Results:
- Mean maximal VO2 was 94.9% predicted and mean maximal work rate was 98.0% predicted.
- Repair in infancy (<1 year) was not associated with differences in maximal VO2, peak work rate, peak heart rate, or arrhythmias.
- Older age at testing and male gender were associated with higher maximal VO2.
Conclusions:
- Intermediate-term exercise performance in children undergoing primary complete repair (PCR) for tetralogy of Fallot (TOF) is near normal.
- Performing PCR within the first year of life does not negatively impact subsequent exercise performance.
Abstract:
Primary complete repair (PCR) of tetralogy of Fallot (TOF) is now routinely performed in infancy. Although operative results are excellent, the impact on exercise performance is incompletely understood. We reviewed data of all children with TOF who underwent PCR at our institution and had subsequent maximal cycle ergometer exercise testing between January 1995 and December 2000. Of the 193 patients with TOF who underwent PCR, 57 (30%) underwent exercise testing; maximal tests were available for 50 of 57 (88%). Exercise performance of subjects who underwent PCR at <1 year of age was compared to that of those who underwent repair at >l year of age. The median age at PCR was 10.9 months; 28 subjects (56%) underwent PCR in infancy (<1 year). A transannular incision was employed in the repair in 41 subjects (82%). The mean age at exercise testing was 12.5 +/- 3.2 years. The mean maximal VO2 was 94.9 +/- 18.8% predicted and the mean maximal work rate was 98.0 +/- 20.8% predicted. In multivariate analysis PCR in infancy (age <1 year) was not associated with maximal VO2, peak work rate, peak heart rate, or arrhythmias. Only older age at testing and male gender were significantly associated with higher maximal VO2 (p = 0.005 and p = 0.002, respectively). Intermediate-term exercise performance in subjects who undergo PCR of TOF in early childhood is near normal. Performing PCR in the first year of life does not impact subsequent exercise performance.