Cardiac Function After Tetralogy of Fallot/Complete Atrioventricular Canal Repair

Area of Science:

• Pediatric Cardiology
• Congenital Heart Surgery
• Cardiac Surgery Outcomes

Background:

• Complete atrioventricular canal (CAVC) and tetralogy of Fallot (TOF) repair is increasingly performed in infancy.
• Midterm outcomes, including valve function and residual obstruction, are less understood than perioperative results.

Purpose of the Study:

• To evaluate midterm outcomes after primary repair of CAVC with TOF.
• To assess valve function, ventricular function, and residual obstruction following CAVC/TOF repair.

Main Methods:

• Retrospective review of 20 patients undergoing CAVC/TOF repair between January 2005 and December 2014.
• Two-patch repair for CAVC; TOF repair involved transannular patch or valve-sparing techniques.
• Echocardiographic follow-up to assess cardiac function and obstruction.

Main Results:

• No in-hospital or late mortality; 20% reoperation rate.
• At midterm follow-up (mean 3.0 years), 15% had moderate atrioventricular valve regurgitation and 35% mild stenosis.
• One patient (5%) had moderate right ventricular outflow tract (RVOT) obstruction; moderate pulmonary insufficiency noted in 33% of valve-sparing patients.

Conclusions:

• Complete atrioventricular canal (CAVC) repair concomitant with tetralogy of Fallot (TOF) can be achieved with low mortality.
• Long-term management of the right ventricular outflow tract (RVOT) presents ongoing challenges after CAVC/TOF repair.