Early and Long Term Outcomes of Corrective Operations for Tetralogy of Fallot: An Experience of Two Centers

Abstract

Objectives: Pulmonary valve insufficiency and right ventricular dysfunction may contribute to early and late morbidity and mortality after repair of Tetralogy of Fallot. Right ventricular dysfunction may be attributed to ventriculotomy incision, especially, when it is combined with a transannular patch as employed in the transventricular repair. Transatrial/transpulmonary approach without ventriculotomy and an attempt to preserve the pulmonary valve has been advocated as a method potentially diminishing such adverse events. The prevalence of associated morbidity and mortality and analysis of the results of various surgical approaches for repair of Tetralogy of Fallot formed the basis of this study. Methods: Nine hundred and ninety five patients during 20 yearS period (from 1992 and 2012) with primary diagnosis of Tetralogy of Fallot that underwent total repair operations in two medical centers were analyzed. The mean age of the patients was 2.9 ± 6.9 SE, with female/male ratio of 0.25. The mean long follow-up was 94 months ± 112 SD. Results: Repair via ventriculotomy with transannular patch was the most common technique (n = 627, 63%), followed by infundibulotomy without transannular patch (20%) and transatrial/transpulmonary approach without ventriculotomy (15%). The operative and long term mortality were 3.2% and 4.4%; 2% and 3.1%; 2% and 2.7% respectively. The overall operative and long term mortality for repairs was 2.9% and 3.4%, with high 3.94% and 6.6% respectively for repairs with right ventricular pulmonary valve conduit. There was statistically significant correlation between the type of repair and mortality risk. Use of transannular patch with ventriculotomy was associated with significant increase in overall mortality risk and operative mortality compared with ventriculotomy without transannular patch. [Odds ratio, 2.10; 95% confidence interval: 1.29-3.64]. Operations that have been performed before 2000 have resulted in increased operative risk compared with those performed after 2000. [Odds ratio 1.45; 95% confidence interval: 1.03-2.01]. Conclusions: Overall mortality for Tetralogy of Fallot repair was low. The repair by ventriculotomy with transannular patch was the most common technique and was associated with higher mortality. Repairs through infundibulotomy without transannular patch and repair without ventriculotomy were less common, but were associated with lower mortality. Current advances in management, anatomical substrate of the lesion, choice of a repair and surgical expertise may all determine the mortality risk.