Reparación completa quirúrgica en adultos con situación Fallot no operada o solamente paliada: ¿ficción o realidad?

Abstract

Introduction-objectivesFallot patients, unoperated or just palliated, exceptionally survive into adulthood. Complete surgical repair in these patients is possible if they have adequate size of their pulmonary arteries. We present our experience. MethodsWe studied retrospectively 27 Fallot patients operated (complete surgical repair) from 1991 to 2014 in our adult congenital heart unit. ResultsMean age: 35,6±10,6 years, 59% male, 18,5% prior palliation. Principal diagnosis: double chamber right ventricle+ventricular septal defect (48%), tetralogy of fallot (30%). nyha functional class: i-26%, ii-30%, iii-44%. arrhythmia: 22%. Mean Hematocrit: 49±11%. Associated left pulmonary artery agenesis: 11%, severe aortic regurgitation: 11%. Additional tests showed high gradients between the right ventricle and pulmonary artery, and good biventricular function. We operated by median sternotomy with cardiopulmonary bypass, moderate hypothermia and aortic clamping. Ventricular septal defect was closed from right atrium: 63%. Reconstruction of the right outflow tract was done by preserving the pulmonary valve (78%), interposing bioprosthesis (15%), and using transannular patch (7%). Associated surgery in 5 patients (18.5%): tricuspid (1), aortic (4). Nobody died during inmediate postoperative period. Mean follow-up: 8.4±6.3 years (maximum-19.75). Late mortality: 1-patient. Reoperation in 3 patients (11%) because of residual lesions. Currently functional class i-65%, ii-31%, 4%-iii; sinus rhythm in 92%. ConclusionsComplete surgical repair in adulthood of Fallot patients achieves clinical improvement by eliminating the cyanosis, closing intracardiac shunts, and decreases right ventricular pressure overload. Our results are excellent and allow higher rates of pulmonary annulus preservation regarding children's series.