Prognosis of Fallot's tetralogy after palliative operations: 10-25 year follow-up

The condition of 350 patients with Fallot's tetralogy (FT) who had palliative surgery (aortopulmonary shunt or transventricular valvotomy) was reviewed 10-25 years later: 136 patients (38%) are alive without any further operation, 106 (30%) have recovered completely, and 108 (31%) have died. Actuarial survival at 25 years of the patients who had palliation was 50% compared to 83% for the group who subsequently had complete correction. After the first five years the mortality rates became 5% per year. Of the patients who were not reoperated upon, 33% felt that the quality of their life was normal, 40% were limited, and 27% were severely limited. The older the patient at palliative procedure, the better the clinical course and the longer the interval before another operation, if the latter was needed at all. Of the patients who had a Brock procedure, the survival rate at 25 years was 80% and the clinical condition was good in 72% of the patients who had not been reoperated upon. Comparison with the natural history of unoperated FT reported by others indicates that the palliative procedures prolonged life in our series; mortality continued at a steady rate for a few years after palliative surgery, probably as a function of the severity of the anatomical and functional abnormality, and independently of the age at which the palliative procedure was performed. Among the palliative procedures, the Brock operation was followed by the best results both in relieving symptoms and in prolonging life.