Long-Term Outcomes in Infants After Tetralogy of Fallot Repair: Does Repair Strategy Matter?

Many studies of tetralogy of Fallot (TOF) with pulmonary stenosis repair focus on early outcomes. This study aimed to assess associations between TOF repair types and midterm or late outcomes.

This was a single-institution, retrospective cohort study of infant primary TOF repair from 1997 to 2020. Valve-sparing repair was compared with transannular patch repair. Outcomes were postdischarge unplanned reintervention on the pulmonary valve, main pulmonary artery, branch pulmonary artery, other reintervention and a composite of 1 or more of these reinterventions (composite).

Among 622 infants undergoing TOF repair with postdischarge follow-up, median follow-up was 7.3 years (interquartile range, 2.8-13.6 years). In the analytic cohort (n = 607), 376 (60%) patients underwent valve-sparing repair, and 231 (37%) patients underwent transannular patch repair. Patients undergoing transannular patch were younger and had smaller pulmonary valve or branch pulmonary artery z- scores. There were 88 (14%) valvular, 11 (2%) main pulmonary artery, 58 (9%) branch pulmonary artery, and 50 (8%) other reinterventions. There was no significant difference in time to valvular intervention, and the valve-sparing group demonstrated a longer time to composite reinterventions. Neonatal age and preoperative PV z score less than or equal to -2.5 were associated with PV reintervention. Transannular patch repair, neonatal age, and preoperative left or right pulmonary artery z score less than or equal to -2.5 were associated with composite reintervention.

A preoperative pulmonary valve z score less than or equal to -2.5 and neonatal repair are associated with PV and composite reintervention, and in this study reinterventions occurred later if valve-sparing repair could be achieved. Babies with small pulmonary valves (z score less than -2.5) and those requiring valve repair in the neonatal period warrant closer monitoring for residua.