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Contemporary patterns of management of tetralogy of Fallot: data from the Society of Thoracic Surgeons database

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Al Habib, Hamad F., Jacobs, Jeffrey Phillip, Mavroudis, Constantine, Tchervenkov, Christo I., O'Brien, Sean M., Mohammadi, Siamak, Jacobs, Marshall L.·2010·The Annals of Thoracic Surgery
DOI 10.1016/j.athoracsur.2010.03.110
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Abstract

Background The Society of Thoracic Surgeons Database was queried to ascertain current trends in management of tetralogy of Fallot (TOF) and to determine the prevalence of various surgical techniques.Methods The study population (n = 3059 operations) was all index operations in 2002-2007, age 0-18 years with Primary Diagnosis of TOF, and Primary Procedure TOF repair or palliation. Patients with Pulmonary Atresia, Absent Pulmonary Valve, and Atrioventricular Canal were excluded.Results 294 patients had initial palliation, including 178 neonates. 2534 patients had repair of TOF as the initial operation (primary repair), including 154 neonates. 217 patients had repair of TOF after prior palliation. Of patients who had primary repair (n = 2534), 975 had repair at 3 to 6 months, 614 at 6 months to 1 year, 492 at 1 to 3 months, and 154 at 0 to 30 days. Of patients who had repair following prior palliation (n = 217), 65 had repair in the first 6 months of life, 111 at 6 months to 1 year, and only 41 (18.9%) at more than 1 year of age. Type of repair: Of 2534 primary repairs, 581 (23%) had no ventriculotomy, 571 (23%) had nontransanular patch, 1329 (52%) had transanular patch, and 53 (2%) had right ventricle to pulmonary artery conduits. Of repairs after prior palliation (n = 217), 20 (9%) had no ventriculotomy, 30 (14%) had nontransanular patch, 144 (66%) had transanular patch, and 24 (11%) had conduits. Discharge mortality (95% confidence interval; CI) was 22 of 294 (7.5%; CI: 4.7%-11.1%) for initial palliation, 33 of 2534 (1.3%; CI: 0.9%-1.8%) for primary repair, and 2 of 217 (0.9%; CI: 0.1%-3.3%) for secondary repair. For neonates, discharge mortality was 11 of 178 (6.2%; CI: 3.1%-10.8%) for palliation and 12 of 154 (7.8%; CI: 4.1%-13.2%) for primary repair.Conclusions Primary repair in the first year of life is the most prevalent strategy. Despite contemporary awareness of the late consequences of pulmonary insufficiency, ventriculotomy with transanular patch remains the most prevalent technique, both for primary repair and for repair following palliation.

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  • An analysis from the Society of Thoracic Surgeons database showed a perioperative mortality of 1.3%.

    “In contrast, an analysis from the Society of Thoracic Surgeons (STS) database showed a perioperative mortality of 1.3%.5”

    From Tetralogy of Fallot in Low- and Middle-Income Countries (2024) · cites this paper as [5]

    The Mortality passage under “Operation Types and Age at Operation” (page unavailable) reports 1.3% discharge mortality for tetralogy of Fallot repair without a previous cardiac operation. The citing sentence omits that restriction and calls the measure perioperative mortality; the paper reports different discharge-mortality rates for palliation and repair after a previous operation. (LLM, conf=0.86)

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Authors
Al Habib, H. F., Jacobs, J. P., Mavroudis, C., Tchervenkov, C. I., O'Brien, S. M., Mohammadi, S., & Jacobs, M. L.
Affiliations
  • University of South Florida (US)
  • Cleveland Clinic (US)
  • Montreal Children's Hospital (CA)
Corresponding author
Jacobs, Jeffrey Phillip
ORCID
Venue
The Annals of Thoracic Surgery
Publisher
Elsevier BV
Published
2010-09
Volume
90
Issue
3
Pages
813-820
ISSN
0003-4975 (ISSN-L)
DOI
10.1016/j.athoracsur.2010.03.110
OpenAlex
W2090146220
Cited by
307
References
25
Citations by year
2026: 12 · 2025: 11 · 2024: 23 · 2023: 23 · 2022: 20 · 2021: 28 · 2020: 26 · 2019: 28 · 2018: 17 · 2017: 24 · 2016: 23 · 2015: 12 · 2014: 20 · 2013: 25 · 2012: 9
FWCI
8.84
Type
journal article
Language
en
Open access
Licence
Locations
  • The Annals of Thoracic Surgery (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Epidemiology › Congenital Heart Disease Studies
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Congenital heart defects research
  • Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiovascular Conditions and Treatments
Keywords
tetralogy of Fallot, surgical repair, palliative care, timing of repair, ventriculotomy, right ventricle to pulmonary artery conduit, discharge mortality, neonates, pediatric cardiac surgery, Society of Thoracic Surgeons database, surgical technique trends, congenital heart disease outcomes, pulmonary atresia, atrioventricular canal, absent pulmonary valve syndrome
MeSH terms
Adolescent, Child, Child, Preschool, Cardiac Surgical Procedures, Humans, Infant, Infant, Newborn, Practice Patterns, Physicians', Retrospective Studies, Societies, Medical, Tetralogy of Fallot, Thoracic Surgery, Databases, Factual

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