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Long-term results after early primary repair of tetralogy of Fallot.
Open accessAbstract
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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“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]
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“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]
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“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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Metadata
- 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)
- 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)
- 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
- bronze
- doi.org
- Licence
- Locations
- Journal of Thoracic and Cardiovascular Surgery (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Congenital Heart Disease Studies
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Congenital heart defects research
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › 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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