Late results after repair of tetralogy of Fallot

Abstract

Three hundred eleven patients up to 17 years of age underwent repair of tetralogy of Fallot from 1964 through 1970. Age of early death group versus early survivor group was 6.1 versus 7.5 years (p = 0.03), and the right ventricular–to–left ventricular (RVILV) pressure ratio was higher for the early death group—0.663 versus 0.569 (p < 0.01). Use of an outflow tract patch was associated with only a minimally higher early mortality rate (p = 0.07). Of early survivors, late results were ideal in 80 per cent, fair in 10 per cent, and poor in 3 per cent; the late mortality rate was 4 per cent. Five per cent had residual hemodynamic defects. The mean cardiothoracic (CT) ratio was 0.485 for the group with ideal results and 0.567 for those with poor results. The RV/LV pressure ratio after repair was considerably higher in the group with poor results (0.74 versus 0.56). These studies give support for (1) the need to achieve as complete a repair of pulmonary stenosis as possible, even if pulmonary insufficiency results and an outflow tract patch is required, and (2) continued avoidance of the insertion of a substitute pulmonary valve during repair of tetralogy in the typical patient until the long-term fate of such valves is known.