Long-term outcomes of transatrial-transpulmonary repair of tetralogy of Fallot.
Open accessAbstract
OBJECTIVES: The surgical approach to repair of tetralogy of Fallot (ToF) has shifted over the years. We aimed to report the long-term follow-up after ToF repair with the transatrial-transpulmonary approach and to determine predictors of long-term outcomes. METHODS: Retrospective analysis of patients operated on in two tertiary referral centres. Primary outcome measures were: death, pulmonary valve replacement (PVR), reintervention for other reasons, internal cardiodefibrillator and/or pacemaker placement. Kaplan-Meier assessment of overall and event-free survival as well as uni- and multivariate analyses of risk factors for outcomes were performed. RESULTS: Four hundred and fifty-three patients were included. Median age at operation was: 0.6 years (range 0-19.6) and median age at the last follow-up was 14.3 years (range 0.1-42.1). Median age at repair decreased from 1.2 years (range 0.6-5.8) (1970-80) to 0.3 years (range 0-4.7) (2000-12). A transannular patch (TP) was used in 65% of all patients. The use of a TP showed a decline from 89% in the initial years of the cohort to 64% in 2000-12. Early mortality was 1.1% (5 patients) for the entire cohort and late mortality 2.4% (11 patients). Overall survival for the entire cohort was 97.3% (95% CI 95.7-98.8) and 91.8% (95% CI 85.9-97.7) at 10 and 25 years, respectively. For patients with a TP (n = 294) vs non-TP (n = 159), this was 97.2% (95% CI 95.2-99.2) vs 97.5% (95% CI 95.1-99.9) at 10-year and 91.0% (95% CI 83.9-98.1) vs 96.3% (95% CI 93.0-99.6) at 25-year follow-up (P = 0.958). Fifty-two patients underwent PVR, and in 5 a pacemaker was inserted. Event-free survival for TP versus non-TP patients was 80.2% (95 CI% 75.5-84.9) vs 81.7% (95% CI 75.2-88.2) at 10-year and 27.9% (95% CI 17.7-38.1) vs 78.5% (95% CI 71.4-85.6) at 25-year follow-up (P = 0.016). In multivariate analysis, both the use of a TP (HR 1.705, 95% CI 1.023-2.842) and the year of surgical repair of tetralogy of Fallot (HR 1.039, 95% CI 1.006-1.073) were associated with a higher probability of an event. CONCLUSIONS: ToF patients corrected with the transatrial-transpulmonary approach have good long-term survival. PVR is a frequent event at longer follow-up, and other events are limited. The use of a TP is a predictor for poorer event-free outcomes, increasing the risk of the composite endpoint 1.7 times.
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Right ventricle dilatation usually prompts the replacement of the native pulmonary valve at some time during follow-up, with the burden of redo operations every 10 to 15 years thereafter.
“Right ventricle dilatation therefore usually prompts the replacement of the native pulmonary valve at some time during follow-up, with the burden of redo operations every 10 to 15 years thereafter.12,13”
From Comparison of Long-term Outcomes of Valve-Sparing and Transannular Patch Procedures for Correction of Tetralogy of Fallot (2021) · cites this paper as [13]
The Discussion (page unavailable) links right-ventricular dilatation to considerations for pulmonary valve replacement and says many late reinterventions are replacements. But the Long-term outcomes section (page unavailable) reports a first replacement in only 11.5% of patients, at a median of 20.2 years after repair. It does not establish that replacement is usual or that redo operations recur every 10–15 years thereafter. (LLM, conf=0.87)
Experimental — accuracy not yet measuredPrior studies detected no significant difference in long-term survival between patients treated with transannular patch (TAP) vs those with valve-sparing operation despite less valve replacements in the valve-sparing group.
“In regards to the use of valve vs nonvalve-sparing approach, prior studies detected no significant difference in long-term survival between patients treated with transannular patch (TAP) vs those with valve-sparing operation despite less valve replacements in the valve-sparing group.23,24”
From Long-term Outcomes of Tetralogy of Fallot: A Study From the Pediatric Cardiac Care Consortium (2019) · cites this paper as [24]
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Long-term Outcomes of Tetralogy of Fallot: A Study From the Pediatric Cardiac Care Consortium
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- Authors
- Luijten, L. W. G., van den Bosch, E., Duppen, N., Tanke, R., Roos-Hesselink, J., Nijveld, A., van Dijk, A., Bogers, A. J. J. C., van Domburg, R., & Helbing, W. A.
- Affiliations
- Erasmus MC (NL)
- Radboud University Medical Center (NL)
- Corresponding author
- Helbing, Willem A.
- Venue
- European Journal of Cardio-Thoracic Surgery
- Publisher
- Oxford University Press (OUP)
- Published
- 2014-05-06
- Volume
- 47
- Issue
- 3
- Pages
- 527-534
- ISSN
- 1010-7940 (ISSN-L)
- 1873-734X
- OpenAlex
- W2119242642
- Cited by
- 72
- References
- 25
- Citations by year
- 2026: 2 · 2025: 6 · 2024: 5 · 2023: 5 · 2022: 8 · 2021: 10 · 2020: 5 · 2019: 9 · 2018: 6 · 2017: 6 · 2016: 5 · 2015: 2 · 2014: 3
- FWCI
- 4.03
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- European Journal of Cardio-Thoracic Surgery (publishedVersion)
- PubMed (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (publishedVersion, other-oa)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion)
- 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 outcomes, overall survival, pulmonary valve replacement, reintervention, pacemaker implantation, risk factors, congenital heart surgery, age at repair, pulmonary regurgitation, pulmonary valve stenosis, pulmonary valve insufficiency
- MeSH terms
- Adolescent, Adult, Child, Child, Preschool, Female, Follow-Up Studies, Cardiac Surgical Procedures, Humans, Infant, Infant, Newborn, Male, Middle Aged, Pulmonary Valve, Retrospective Studies, Tetralogy of Fallot, Treatment Outcome, Kaplan-Meier Estimate, Young Adult
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