The Journal of Thoracic and Cardiovascular Surgery
Congenital: Tetralogy of FallotLong-term outcomes of tetralogy of Fallot repair: A 30-year experience with 960 patients
Graphical Abstract
Section snippets
Study Population and Data Collection
We performed a retrospective study of 960 consecutive patients who underwent TOF repair at the Royal Children's Hospital Melbourne, Australia, between January 1990 and July 2020. We excluded patients with associated pulmonary atresia, absent pulmonary valve (PV), atrioventricular septal defect, and double outlet right ventricle (RV) (>50% overriding the aorta) (Figure E1). Patients referred from overseas were also excluded because of the lack of follow-up data. Medical records were reviewed.
Results
During the study period, a total of 960 consecutive patients underwent TOF repair at our institution. Table 1 displays baseline demographics of patients divided by time periods (Era 1: 1990-1999, Era 2: 2000-2009, Era 3: 2010-2020). The median age at TOF repair decreased over the decades. In Era 1, the median age at TOF repair was 12.9 months (IQR, 9.4-17.0) compared with 6.3 months (IQR, 5.4-8.1) in Era 3, P < .001. For the entire cohort, 61 patients underwent TOF repair at less than 4 months
Discussion
Over the last 30 years, we have consistently aimed to perform a transatrial transpulmonary TOF repair between 4 and 6 months of age, with a preference for valve-preserving surgery when feasible. We assessed the outcomes of this strategy. In particular, it appeared to us that leaving some gradient across RVOT may prolong the time until PVR. Thus, we aimed to determine the optimal gradient that would not increase the risk of reoperation.
A recent meta-analysis revealed improved survival after TOF
Conclusions
Over the last 3 decades, TOF repair has been associated with excellent long-term survival. Mortality was related to the underlying genetic condition. In recent years, surgery has been performed earlier, reducing the need for a palliative shunt, but at the cost of higher rate of reintervention for RVOT obstruction. In matched patients with mild PV annulus hypoplasia, the valve preservation strategy delays PVR. Thus, in suitable patients, in whom a peak gradient of less than 25 mm Hg can be
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Institutional Review Board approval: HERC 38341, April 5, 2019.
S.I. and X.T.Y. contributed equally to this article.