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Primary early correction of tetralogy of Fallot irrespective of age

Andrea Kantorova1, Kai Zbieranek, Henning Sauer

  • 1Slovak Pediatric Heart Centre, Bratislava, Slovakia.

Cardiology in the Young
|February 7, 2008
PubMed

Insights

Primary repair of tetralogy of Fallot in infants younger than 6 months is safe and effective. This approach offers excellent midterm outcomes with acceptable morbidity and reintervention rates, regardless of age at surgery.

Area of Science:

  • Pediatric Cardiology
  • Congenital Heart Surgery
  • Neonatal Intensive Care

Background:

  • The optimal surgical timing for tetralogy of Fallot (TOF) remains debated, with strategies ranging from early primary repair to initial palliation.
  • Early repair policies aim to avoid staged palliation and its associated risks.

Purpose of the Study:

  • To evaluate the midterm outcomes of primary early correction for tetralogy of Fallot in infants under 6 months of age.
  • To compare outcomes between infants operated on before and after 3 months of age.

Main Methods:

  • A cohort of 61 consecutive infants (<6 months) underwent primary TOF repair between 1996 and 2005.
  • Patients were stratified into two groups: <3 months and 3-6 months at the time of surgery.
  • Midterm outcomes including survival, reoperation rates, and postoperative complications were analyzed.

Main Results:

  • Actuarial survival was excellent at 98.4% at 1 year, 96.7% at 5 years, and 96.7% at 10 years, with a median follow-up of 4.5 years.
  • No significant differences in survival, bypass time, ventilation duration, or hospital stay were observed between the age groups.
  • Freedom from reoperation was high (98.2% at 1 year, 92.2% at 5 years, 83% at 10 years) with no significant difference between groups.

Conclusions:

  • Primary repair of tetralogy of Fallot in infants under 6 months is a safe and effective strategy, yielding excellent midterm results.
  • The approach is suitable for symptomatic infants regardless of age, weight, or preoperative condition.
  • Long-term evaluation focusing on arrhythmias, ventricular function, and exercise performance is warranted.
Abstract

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