Outcome after repair of tetralogy of Fallot in the first year of life
Open accessAbstract
Background The purpose of this study was to evaluate the early and late outcome after repair of tetralogy of Fallot in the first year of life.Methods Between 1974 and 2000, 89 consecutive infants with a mean age of 6.3 +/- 2.6 months (range, 15 days to 12 months) underwent repair of tetralogy of Fallot (ventricular septal defect and pulmonary stenosis) by one surgeon (J.L.M.). Three infants had previous palliative operations. Sixty-seven procedures were urgent or emergency. A transannular patch was inserted in 69 patients (77.5%). Follow-up was complete, averaging 13.4 +/- 5.6 years (range, 0 to 25.4 years).Results There was one operative death (1.1%). Mean right ventricular to left ventricular pressure ratio postoperatively was 0.4 +/- 1.1 (in 79 patients, < 0.5). Fourteen patients underwent reoperations or reinterventions. There were no reoperations for residual or recurrent ventricular septal defect. Kaplan-Meier freedom from reoperation or reintervention for any cause at 20 years was 85% +/- 4.4%, for relief of right ventricular outflow tract obstruction it was 94% +/- 3.1%, and for pulmonary valve replacement this was 95.4% +/- 2.6%. Use of a transannular patch did not significantly affect the need for reoperation or reintervention. There was one late death (leukemia). Kaplan-Meier 20-year survival was 97.8% +/- 1.9%. On latest echocardiography, 42 patients had moderate pulmonary regurgitation, 4 had a right ventricular outflow tract gradient more than 40 mm Hg, and 86 had good biventricular function. Twelve-lead electrocardiography was performed in all and 24-hour electrocardiography in 61 patients. One patient (1.1%) exhibited late recurrent ventricular tachycardia requiring implantation of a defibrillator. The remaining 86 patients are in New York Heart Association class I with none of them receiving antiarrhythmic medications.Conclusions These data strongly support the concept of early repair of tetralogy of Fallot. It is associated with an acceptable operative risk and a low incidence of significant arrhythmias, and provides long-term survival similar to that observed in the general population. Late complications may, however, develop, and long-term follow-up for their early recognition is essential.
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The benefits of valve-sparing techniques for decreasing the risk of reintervention have been demonstrated when pulmonary annulus is well developed.
“The benefits of valve-sparing (VS) techniques for decreasing the risk of reintervention have been demonstrated when pulmonary annulus is well developed.5,14”
From Comparison of Long-term Outcomes of Valve-Sparing and Transannular Patch Procedures for Correction of Tetralogy of Fallot (2021) · cites this paper as [5]
In Reoperations and Reinterventions (page not provided), all six patients who required pulmonary valve replacement had received a transannular patch, consistent with a possible benefit of preserving the valve. But the paper found no significant difference in overall reoperation or reintervention between patch and simple-repair groups (p = 0.8), and it did not demonstrate a reduced reintervention risk specifically in patients with a well-developed pulmonary annulus. (LLM, conf=0.87)
Experimental — accuracy not yet measuredProlonged bypass and cross-clamp times are well-established predictors of postoperative complications, including low cardiac output syndrome and prolonged ICU stay.
“Prolonged bypass and cross-clamp times are well-established as predictors of postoperative complications, including low cardiac output syndrome and prolonged ICU stay [13–14].”
From Management of tetralogy of fallot in developing countries: opportunities and challenges for surgeons (2026) · cites this paper as [14]
The operative-details passage reports mean cardiopulmonary bypass duration, and the Operative Mortality and Morbidity section lists early complications, but neither links longer bypass time to those outcomes. Searches for cross-clamp time, low cardiac output syndrome, and prolonged ICU stay found no passage establishing the claimed predictors; page numbers were unavailable in our copy. (LLM, conf=0.74)
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References 31 · Cited by 98
Research works printed but not linked: 3
- [11]11. Kirklin JW, Blackstone EH, Jonas RA, et al. Morphologic and surgical determinants of outcome events after repair of tetralogy of Fallot and pulmonary stenosis. J Thorac Cardio- vasc Surg 1992;103:706-23.
- [13]13. Karl TR, Sano S, Pornviliwan S, Mee RBB. Tetralogy of Fallot: favorable outcome of non-neonatal transatrial, transpulmo- nary repair. Ann Thorac Surg 1992;54:903-7.
- [22]22. McGoon DC, Baird DK, Davis GD. Surgical management of large bronchial collaterals with pulmonary stenosis or atre- sia. Circulation 1975;52:109-18.
- Authors
- Alexiou, C., Mahmoud, H., Al-Khaddour, A., Gnanapragasam, J., Salmon, A. P., Keeton, B. R., & Monro, J. L.
- Affiliations
- Southampton General Hospital (GB)
- Corresponding author
- Monro, James L
- ORCID
- Alexiou, Christos
- Venue
- The Annals of Thoracic Surgery
- Publisher
- Elsevier BV
- Published
- 2001-02
- Volume
- 71
- Issue
- 2
- Pages
- 494-500
- ISSN
- 0003-4975 (ISSN-L)
- OpenAlex
- W2017953774
- Semantic Scholar
- adbc966b83211b0d8ef53384019dbbc86096c601
- Cited by
- 98
- References
- 31
- Citations by year
- 2026: 1 · 2024: 2 · 2023: 4 · 2022: 3 · 2021: 1 · 2020: 2 · 2019: 4 · 2018: 6 · 2017: 5 · 2016: 3 · 2014: 2 · 2013: 4 · 2012: 1
- FWCI
- 4.56
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The Annals of Thoracic Surgery (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Epidemiology › Congenital Heart Disease Studies
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiovascular Conditions and Treatments
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Congenital heart defects research
- Keywords
- tetralogy of Fallot, early surgical repair, infants, transannular patch, ventricular septal defect, pulmonary stenosis, right ventricular outflow tract obstruction, reoperation, pulmonary valve replacement, pulmonary regurgitation, long-term survival, late mortality, cardiac arrhythmias, congenital heart surgery outcomes
- MeSH terms
- Adolescent, Adult, Child, Child, Preschool, Female, Follow-Up Studies, Humans, Infant, Infant, Newborn, Male, Postoperative Complications, Reoperation, Tetralogy of Fallot, Treatment Outcome
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