Methods: Follow-up study of 101 patients operated with the diagnosis of uncomplicated tetralogy of Fallot (TOF) between 12.1994 and 12.2007. There were three perioperative deaths. From the 98 survivors N=55 (56.1%) were operated either via a classical transpulmonary /transanular, N=5 (5.1%) via pure transventricular and N=38 (38.8%) through a pure transatrial approach. Intraoperatively the pulmonary valve was either resected during the transanular repair, or progressively torn with Hegar dilators in all other cases. 6 patients were palliated preoperatively, either with a shunt (N=3) or a palliative balloon pulmonary valvuloplasty (N=3)
Results: The transatrially operated patients were older than those operated by a non-transatrial approach (11.82 vs 5.48 months p=0.037). Over an average follow-up of 79.94 months (SD=50.97) 18 patients (18.3%) required secondary pulmonary valve replacement (16 pulmonary homografts and 2 xenografts). The incidence of the PVR was not significantly different between the various approaches 11/55 in the transanular vs 7/43 in the non-transanular group (p=0.79), however, PVR was required earlier postoperatively in the transanular group than in the non-transanular patients (69.9 vs 126.8 months p=0.02). Age alone (independent of the surgical approach) at the primary operation did not predict the need for PVR either: 1/11 neonates vs 17/87 nonneonates (p=0.35) or 8/39 vs 11/59 (p=0.42) in young infants(<6 months old) vs older patients
Conclusion: Secondary pulmonary valve replacement is required in a significant proportion of surgically corrected TOF. Transatrial approach does not significantly reduce the incidence of the PVR, although in our series it significantly delays it.