Cited by 761Congenital Heart Disease StudiesCardiovascular Conditions and TreatmentsCongenital heart defects research

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Long-term survival in patients with repair of tetralogy of Fallot: 36-year follow-up of 490 survivors of the first year after surgical repair.

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Nollert, Georg, Fischlein, Teddy, Bouterwek, Stefan, Böhmer, Christine, Klinner, Werner, Reichart, Bruno·1997·Journal of the American College of Cardiology

DOI 10.1016/s0735-1097(97)00318-5

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Abstract

Objectives We sought to analyze risk factors for long-term survival (up to 36 years) after surgical repair of tetralogy of Fallot (TOF).Background Survival after repair is excellent, but data >20 years are rare.Methods From 1958 to 1977, 658 patients underwent correction of TOF at our institution and were analyzed for survival. Of this patient group (age 12.2 +/- 8.6 years [mean +/- SD], range 2 to 67), 39.7% had a previous palliation. Operative (n = 139) and 1-year (n = 29) deaths were excluded for long-term calculations, resulting in a study group of 490 patients.Results Actuarial 10-, 20-, 30- and 36-year survival rates were 97%, 94%, 89% and 85%, respectively. Mortality increased 25 years postoperatively from 0.24%/year to 0.94%/year (p = 0.003). The most common cause of death was sudden death (n = 13), followed by congestive heart failure (n = 6). Multivariate correlates of impaired long-term survival were date of operation (before 1970, p = 0.0104), preoperative polycythemia (p = 0.0487) and use of a right ventricular (RV) outflow patch (p = 0.0079). Postoperative systolic RV/left ventricular pressure ratio and age showed no influence. Patients without preoperative polycythemia and an RV outflow patch (n = 164) had a 36-year actuarial survival rate of 96% and normal life expectancy.Conclusions Cyanosis, operative experience of the surgeon and an RV outflow tract patch influence long-term outcome after repair of TOF in older children. Early repair by experienced surgeons to avoid polycythemia and excessive RV hypertrophy is supported by this study. However, mortality risk increases 25 years postoperatively, and thus heart monitoring should be intensified.

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Authors: Nollert, G., Fischlein, T., Bouterwek, S., Böhmer, C., Klinner, W., & Reichart, B.
Affiliations: Ludwig-Maximilians-Universität München (DE)
Corresponding author: Nollert, Georg
ORCID: Nollert, Georg
Reichart, Bruno
Venue: Journal of the American College of Cardiology
Publisher: Elsevier BV
Published: 1997-11
Volume: 30
Issue: 5
Pages: 1374-1383
ISSN: 0735-1097 (ISSN-L)
DOI: 10.1016/s0735-1097(97)00318-5
OpenAlex: W2022043412
Cited by: 761
References: 32
Citations by year: 2026: 11 · 2025: 19 · 2024: 23 · 2023: 25 · 2022: 18 · 2021: 25 · 2020: 39 · 2019: 37 · 2018: 35 · 2017: 36 · 2016: 44 · 2015: 28 · 2014: 37 · 2013: 45 · 2012: 49
FWCI: 6.24
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/open-access/userlicense/1.0/ (vor, 5736 d)
Locations: Journal of the American College of Cardiology (publishedVersion)
PubMed (publishedVersion)
Funders: Deutsche Forschungsgemeinschaft
Topics: Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Congenital Heart Disease Studies
Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Cardiovascular Conditions and Treatments
Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Congenital heart defects research
Keywords: tetralogy of Fallot, surgical repair, long-term survival, mortality risk factors, sudden death, congestive heart failure, cyanosis, right ventricular hypertrophy, timing of repair, congenital heart disease
MeSH terms: Actuarial Analysis, Cause of Death, Child, Child, Preschool, Female, Follow-Up Studies, Humans, Male, Pulmonary Valve Stenosis, Reoperation, Risk Factors, Tetralogy of Fallot, Time Factors, Multivariate Analysis, Survival Analysis, Ventricular Function, Left, Ventricular Function, Right

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Long-term survival in patients with repair of tetralogy of Fallot: 36-year follow-up of 490 survivors of the first year after surgical repair.

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