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Cited by 240Congenital Heart Disease StudiesCongenital heart defects researchCardiovascular Conditions and Treatments

Long-term results after early primary repair of tetralogy of Fallot.

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Bacha, Emile A., Scheule, Albertus M., Zurakowski, David, Erickson, Lars C., Hung, Judy, Lang, Peter, Mayer, John E., del Nido, Pedro J. +1 more·2001·The Journal of Thoracic and Cardiovascular Surgery
DOI 10.1067/mtc.2001.115156
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Abstract

Objective Early primary repair of tetralogy of Fallot has been routinely performed at Children's Hospital, Boston, since 1972. We evaluated the long-term outcome of this treatment strategy including the influence of a transannular patch.Methods Fifty-seven patients less than 24 months of age (median 8 months) underwent primary repair of tetralogy of Fallot between January 1972 and December 1977. Thirty-one patients had a transannular patch. Survival and freedom from reintervention were determined by the Kaplan-Meier method with 95% confidence intervals.Results There were 8 early deaths, and 1 patient died 24 years after initial repair. Recent follow-up was obtained for 45 of the 49 long-term survivors (92%). Median follow-up was 23.5 years. Ten patients underwent reintervention, 8 of whom underwent relief of right ventricular outflow tract obstruction. Right ventricular outflow tract obstruction occurred in 6 patients without a transannular patch and 2 with a transannular patch (33% vs 6%, P =.04). One pulmonary valve replacement was performed at another institution 20 years after the repair. Forty-one long-term survivors were in New York Heart Association class I and 4 were in class II. Actuarial survival was 86% at 20 years (95% confidence intervals = 80%-92%). Freedom from reintervention was 93% at 5 years (95% confidence intervals = 87%-99%) and 79% at 20 years (95% confidence intervals = 70%-86%). No significant differences were found between patients with and without a transannular patch (survival, P =.34; freedom from reintervention, P =.09, log-rank tests).Conclusions Long-term survival is excellent and the freedom from reintervention is satisfactory after early primary repair of tetralogy of Fallot in the 1970s. Use of a transannular patch does not reduce late survival and is associated with a lower incidence of right ventricular outflow tract obstruction.

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  • Studies based on multicenter surgical registries found increased survival and decreased reintervention rates among patients who underwent a VS procedure compared with those who underwent TAP.

    “The risk-benefit balance of VS procedures compared with TAP remains unclear in this setting even if studies3,16,17,18,19,20 based on multicenter surgical registries found increased survival and decreased reintervention rates among patients who underwent a VS procedure compared with those who underwent TAP.”

    From Comparison of Long-term Outcomes of Valve-Sparing and Transannular Patch Procedures for Correction of Tetralogy of Fallot (2021) · cites this paper as [20]

    The Survival section reports no difference in long-term survival between TAP and non-TAP patients. The Reintervention section reports no significant difference in reintervention rates; its nonsignificant trend favored TAP, not valve-sparing repair. The paper also describes its own patient series rather than a multicenter surgical registry. (LLM, conf=0.90)

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  • Many studies found no difference in survival comparing TAP and VS procedures.

    “Many studies found no difference in survival comparing TAP and VS procedures,11,18,20,32,33,34,36,37,38,40”

    From Comparison of Long-term Outcomes of Valve-Sparing and Transannular Patch Procedures for Correction of Tetralogy of Fallot (2021) · cites this paper as [20]

  • Most previous single center studies did not find a difference in the risk of reintervention comparing surgical procedures for correction of TOF.

    “Most previous single center studies did not find a difference in the risk of reintervention comparing surgical procedures for correction of TOF.18,20,32,38,40”

    From Comparison of Long-term Outcomes of Valve-Sparing and Transannular Patch Procedures for Correction of Tetralogy of Fallot (2021) · cites this paper as [20]

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Authors
Bacha, E. A., Scheule, A. M., Zurakowski, D., Erickson, L. C., Hung, J., Lang, P., Mayer, J. E., del Nido, P. J., & Jonas, R. A.
Affiliations
Boston Children's Hospital (US)
ORCID
Venue
The Journal of Thoracic and Cardiovascular Surgery
Publisher
Elsevier BV
Published
2001-07
Volume
122
Issue
1
Pages
154-161
ISSN
0022-5223 (ISSN-L)
DOI
10.1067/mtc.2001.115156
OpenAlex
W2155350077
Cited by
240
References
28
Citations by year
2026: 4 · 2025: 5 · 2024: 6 · 2023: 5 · 2022: 5 · 2021: 7 · 2020: 14 · 2019: 10 · 2018: 17 · 2017: 14 · 2016: 16 · 2015: 11 · 2014: 16 · 2013: 18 · 2012: 17
FWCI
2.50
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Thoracic and Cardiovascular 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, transannular patch, long-term survival, reintervention, right ventricular outflow tract obstruction, pulmonary valve replacement, infants, congenital heart surgery
MeSH terms
Female, Humans, Infant, Male, Reoperation, Retrospective Studies, Tetralogy of Fallot, Proportional Hazards Models, Treatment Outcome, Exercise Tolerance, Prostheses and Implants

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