A 28 year experience with surgical repair of Tetralogy of Fallot: risk analysis for mortality or late reintervention

  • Dr Andrzej Pastuszko, Poland
  • Dr Andrzej Kansy, Children`s Memorial Health Institute, Warsaw, Poland
  • Dr Piotr Burczynski, Children`s Memorial Health Institute, Warsaw, Poland
  • Dr Mariusz Birbach, Children`s Memorial Health Institute, Warsaw, Poland
  • Dr Wojciech Lipinski, Children`s Memorial Health Institute, Warsaw, Poland
  • Dr Malgorzata Mirkowicz-Malek, Children`s Memorial Health Institute, Warsaw, Poland
  • Dr Grazyna Brzezinska, Children`s Memorial Health Institute, Warsaw, Poland
  • Dr Bohdan Maruszewski, Children`s Memorial Health Institute, Warsaw, Poland

    • Objective:
    Early results after repair of Tetralogy of Fallot have improved importantly during last decades. Data on long term outcomes are limited.
    Methods:
    773 patients underwent repair of TOF including TOF with pulmonary atresia between 1980 and 1999. Mean age at surgery was 73,6 months before 1990 and 57,5 after (p<0,001). 70% of patients (540) underwent one-stage repair. Transventricular approach was used in 399 patients, 283 had transannular enlargement, 69 were repaired transatrially. 22 RV-PA conduits were interposed. IPPV and LOS times significantly decreased in later decade as well as number of complications. Mean hospital mortality was 10,6% before and 4,6% after 1989. Hospital mortality did not differ between surgical techniques. Multivariate analysis showed that only surgical era and type of repair were risk factors for early death.
    Results:
    Mean late follow-up was 18,6 years (8,9-28,2,SD 5,5) and was available in660 patients (95,5%). Late dysrhythmia occured in 23% of survivors, most frequently VEx ,11,5%. There were 11 reoperations and 31 catheter interventions. Freedom from any reintervention after repair was 97,6%, 95,8% and 94,1% 5, 10, and 15 years respectively. The lowest risk of late reintervention was associated with transventricular approach (3,19%). Late mortality was 1,2% (8 deaths). Cumulative overall survival is 88,1% independent on surgical technique, age at surgery and era at repair.
    Conclusions:
    Early mortality after repair of TOF has significantly decreased over last decades and late survival is excellent. Continuous monitoring of late outcomes in recent population of young infants after primary repairs is mandatory.