to evaluate clinical outcomes of patients undergoing Tetralogy of Fallot (ToF) repair, focusing on the type of surgical strategy performed.
a retrospective clinical review of patients undergoing ToF repair in six centers. Excluded were ToF with pulmonary atresia or aplasia, and double-outlet right ventricle.
between 1990 and 2015, 720 patients underwent ToF repair (M/F 57%/43%; median age 5,9months, IQ range 3,8–11,5); 132 (18%) had preoperative cyanotic spells; 111 (15%) received previous palliative surgery. Repair was achieved by transatrial approach (TA) in 433 patients (60,1%), and transventricular (TV) in the remaining ones. The pulmonary valve (PV) was saved in 249 (34,6%), while, in the remaining patients, RVOT reconstruction was performed by means of a transanular patch (60,8%), or a conduit (4,6%). Major postoperative complications occurred in 247 (34,0%). Early mortality was 3%.
At 20-year follow-up (completeness 86%), 10 (2%) patients died, 39 (7%) required surgical reoperation, and 72 (12%) an interventional procedure. There were no significant differences between TA and TV approaches, in terms of early mortality and onset of adverse events (interventional procedures, surgical reoperations and mortality) at follow-up. When PV was saved, there was a lower rate of postoperative complications and early mortality, and a lower rate of overall adverse events (Figure 1, p < 0,05).
ToF repair in infancy is confirmed to be a safe procedure, with good late clinical outcomes. PV preservation at repair is associated with lower early morbidity and mortality, and a lower rate of adverse events at long-term follow up.
1UOC Cardiochirurgia Pediatrica e Cardiopatie Congenite, Dipartimento di Scienze Cardiologiche Toraciche e Vascolari, Università di Padova Padova
2Biostatistica, Dipartimento di Scienze Cardiologiche Toraciche e Vascolari, Università di Padova Padova
3Dipartimento di Cardiochirurgia, Ospedale Giovanni XXIII Bergamo
4UOC Cardiochirurgia Pediatrica, Ospedale Regina Margherita Torino
5UOC Cardiochirurgia Pediatrica, Centro Mediterraneo Taormina Taormina
6UOC Cardiochirurgia Pediatrica, Università Federico II Napoli
7SS Cardiochirurgia Pediatrica e del Congenito Adulto, ASST Niguarda Milano Milano