Surgical treatment of tetralogy of Fallot. Recent experience using a prospective protocol

Two hundred eighteen consecutive patients with tetralogy of Fallot (TOF) underwent surgical treatment under a prospective protocol during a three-year period (January 1978 to December 1980). No patient was refused the operation. Eighty-three patients had palliative operations without hospital deaths (50% less than 1 year of age). One hundred thirty-five had total correction with 5 hospital deaths (3.7%; 70% C.L. = 2.0 to 6.2). Thirty-five of them had had palliation in the first year of life (one hospital death at time of correction). Incremental risk factors were young age (p less than 0.0002), transannular patch (p = 0.13) and primary repair (p = 0.38). Significant stenosis in the pulmonary artery branches were eliminated utilizing an original table of relationship between the diameter of the expected normal pulmonary valve annulus and the calculated diameter of the branches. The immediate post-repair peak systolic pressure ratio between right and left ventricles (Prv/lv) was only 0.39 and the incidence of transannular patches was remarkably low (34%). It is concluded that surgical management of tetralogy of Fallot can be achieved, today, with a very low hospital mortality reserving a two-stage procedure only for small infants (less than 1 year of age). Accurate criteria for the reconstruction of the right ventricle outflow tract (RVOT) can easily allow very low rates of transannular patches and postoperative RV hypertension with an ultimate better preservation of the RV function.