Mitral Valve Operation After Tetralogy of Fallot Repair: Early and Late Outcomes

Abstract

BackgroundThere is a paucity of data regarding reoperation for mitral valve (MV) disease after tetralogy of Fallot (TOF) repair. We aimed to characterize this population and to analyze outcomes. MethodsPatients with TOF who underwent mitral surgery between January 1971 and December 2020 at Mayo Clinic were reviewed retrospectively. Among 1278 patients who underwent reoperations after TOF repair, 23 (1.8%) had MV surgery and formed the final cohort. ResultsMedian age at MV operation was 52 years (interquartile range, 29.5 years), and time between TOF repair and MV operation was 25.2 years (interquartile range, 37 years). One patient (4.3%) was <18 years old. More than half of patients had ≥2 prior sternotomies. All had severe mitral regurgitation (MR); the most common cause was degenerative/prolapse (n = 17 [73.9%]). The pathologic process was anterior leaflet prolapse (n = 7 [30.4%]), bileaflet (n = 5 [21.7%]), posterior leaflet (n = 1 [4.3%]), or myxomatous change without prolapse (n = 3 [13%]). MV replacement was performed in 13 patients (56.5%) and MV repair in 10 (43.5%), typically using flexible partial annuloplasty bands. Concomitant procedures were performed in 19 patients (82.6%). Early death (within 30 days) occurred in 2 patients (8.7%). During median follow-up of 16.9 months, 6 patients (23.1%) underwent reoperation, 3 of which were MV replacement for recurrent MR. The 5- and 10-year survival was 64% and 56%, respectively. ConclusionsMR after TOF repair is uncommon and rarely occurs in isolation. The most common cause is myxomatous disease from anterior or bileaflet prolapse, and MV replacement is often required. Operative risk and need for reoperation are high and late survival is poor.