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Published on: July 18, 2014
The long-term result of total repair for tetralogy of Fallot
Chun Soo Park1, Jeong Ryul Lee, Hong-Gook Lim
1Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Bucheon, South Korea.
Insights
Total repair for tetralogy of Fallot shows satisfactory long-term outcomes, with survival rates above 90% at 25 years. However, pulmonary atresia impacts survival, and re-operations are common, especially for pulmonary regurgitation.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Congenital Heart Disease
Background:
- Tetralogy of Fallot (TOF) is a complex congenital heart defect requiring surgical intervention.
- Total repair aims to correct the anatomical abnormalities and improve long-term outcomes.
- Evaluating the long-term results of this surgical approach is crucial for patient management.
Purpose of the Study:
- To assess the long-term outcomes following total surgical repair of tetralogy of Fallot.
- To identify risk factors associated with early mortality and late re-intervention.
- To evaluate survival rates and functional status after repair.
Main Methods:
- A retrospective analysis of 734 patients who underwent total repair for TOF between 1986 and 2007.
- Median follow-up duration of 150.2 months.
- Statistical analysis to identify risk factors for mortality and re-operation.
Main Results:
- Overall survival rates were 94.8% at 10 years and 92.8% at 20-25 years.
- Early mortality was 3.7%, with longer cardiopulmonary bypass time and circulatory arrest as risk factors.
- Re-operation was needed in 31.7% of patients, primarily for pulmonary regurgitation and branch pulmonary artery stenosis.
Conclusions:
- Total repair for TOF yields satisfactory long-term results with high survival.
- Pulmonary atresia is a risk factor for poorer late survival.
- Strategies like preserving the pulmonary annulus may reduce re-operation rates.
Objective:
The objective of this study was to evaluate the long-term outcome of total repair for tetralogy of Fallot.
Methods:
Between April 1986 and December 2007, a total of 734 patients underwent total repair for tetralogy of Fallot. There were 444 males and 290 females. The median age and weight were 17.2 months (0.4-329.6 months) and 9.5kg (2.6-53.5kg). The median follow-up duration was 150.2 months (1.9-356.2 months).
Results:
There were 27 early deaths (3.7%) and 13 late deaths. A longer cardiopulmonary bypass time and the use of total circulatory arrest were risk factors for early death. The overall survival rate was 94.8%, 92.8% and 92.8% at 10, 20 and 25 years, respectively. The presence of pulmonary atresia was a risk factor for long-term survival. Re-operation or re-intervention was required in 224 patients (31.7%). The most common causes of re-operation or re-intervention were pulmonary regurgitation in 109 patients and branch pulmonary artery stenosis in 127 patients. Freedom from re-operation or re-intervention rate was 81.5%, 68.9% and 46.6% at 5, 10 and 20 years, respectively. Reconstruction of the right ventricular outflow tract with other than non-trans-annular repair and branch pulmonary arterioplasty at the time of total repair were the risk factors for late re-operation or re-intervention. The use of a monocusp patch was not associated with early mortality or re-operation. At the latest follow-up, most patients were in the New York Heart Association functional class 1 or 2.
Conclusions:
The long-term outcome of total repair for tetralogy of Fallot was satisfactory. A longer cardiopulmonary bypass time and the use of deep hypothermic circulatory arrest were associated with early mortality. The patients with pulmonary atresia have poorer late survival. Preservation of the pulmonary annulus can reduce the re-operation rate. A small pulmonary artery that requires augmentation may increase the risk of re-operation. The use of a monocusp in patients who underwent trans-annular repair has no benefit for early survival, the postoperative recovery and avoidance of re-operation. Age was not a risk factor for early mortality and re-operation.
