Long-term outcomes in adults with repaired tetralogy of Fallot: a single-centre retrospective cohort

Adults with repaired tetralogy of Fallot represent a growing clinical population at risk for long-term cardiovascular complications. Characterising their postoperative course and late outcomes is essential to guide surveillance and management.

To describe the clinical characteristics and long-term outcomes of adult patients (≥18 years) with repaired tetralogy of Fallot who received care at a quaternary-care institution between January 2000 and December 2024.

We performed a retrospective cohort study. Adult patients with a diagnosis of repaired tetralogy of Fallot who had undergone complete surgical repair either during the study period or before it were included. Clinical and sociodemographic data were obtained.Variables related to prior palliative procedures, type of surgical repair, reinterventions (surgical or catheter-based), and long-term outcomes were analysed.

A total of 56 patients were included; 31 (55.4%) were women. The median duration of follow-up after repair was 23 years; twenty patients (35.7%) had undergone a palliative or prior intervention before complete repair. The most common type of outflow tract reconstruction was a transannular patch (37.5%), followed by homograft implantation (25.0%). Reinterventions occurred in 29 patients (51.8%), most commonly pulmonary valve replacement (23 patients, 41.0%), mainly due to progressive pulmonary regurgitation and right ventricular dilation. Arrhythmic complications included premature ventricular contractions in 35.7% of patients. Long-term mortality was 3.6%.

Adults with repaired tetralogy of Fallot demonstrate high long-term survival; however, late complications are common and frequently require surgical or catheter-based reintervention. These findings underscore the need for lifelong specialised follow-up in adult CHD programmes.