Need of transannular patch in tetralogy of Fallot surgery carries a higher risk of reoperation but has no impact on late survival: results of Fallot repair in Finland.
Open accessAbstract
OBJECTIVES: Our study is a population-based evaluation of the long-term results after surgical repair for tetralogy of Fallot (TOF). All patients operated on in the country since the first procedure were identified via the Finnish research database of paediatric cardiac surgery and the Finnish population register. The follow-up was 99% completed due to comprehensive coverage of the registers. METHODS: The Finnish research database of paediatric cardiac surgery, surgical logs, diagnosis cards and computer files of the hospitals were used for data collection. The Finnish Population Register Center was used to obtain current patient status and dates of death and emigration. RESULTS: A total of 600 patients underwent surgical repair of TOF before the age of 15 years during the 46-year period from 1962 to 2007. The mean follow-up time was 23 ± 12.1 years; 513 (85%) patients were alive and living in Finland, 82 (14%) had died and 5 patients were lost to the follow-up (0.8%). A total of 40 patients (7%) died early (≤30 days) and 42 (7%) died late (>30 days) after the surgical correction. During the last two decades the early mortality rate was 1.5% and no early deaths were observed after the year 2000. A transannular patch (TAP) was used in the reconstruction of the right ventricular outflow tract in 191 (32%) of these patients and had no influence on late mortality but the event-free survival was significantly inferior in these patients. If a primary palliation was performed before the correction, the late survival was significantly inferior when compared with patients without initial palliation. Also reoperation was more common in patients with primary palliation. CONCLUSIONS: The long-term prognosis of surgically corrected TOF patients is good and has improved with each decade since the beginning of TOF surgery in Finland. Primary repair of tetralogy of Fallot predicts a lower mortality rate and longer freedom from reoperation when compared with two-stage repair. Need of a TAP in TOF surgery carries a higher risk of reoperation but has no impact on late survival.
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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 [16]
The Results and Discussion report more reoperations among patients who received TAP, supporting the lower-reintervention comparison for patients without TAP. But the Results found no significant mortality difference, and the Discussion states that TAP had no effect on late mortality; the claimed survival advantage is therefore not supported. The paper compares TAP with no TAP, rather than explicitly identifying every no-TAP repair as a VS procedure. (LLM, conf=0.91)
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Cites
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- Authors
- Ylitalo, P., Nieminen, H., Pitkänen, O. M., Jokinen, E., & Sairanen, H.
- Affiliations
- University of Helsinki (FI)
- Corresponding author
- Sairanen, Heikki
- Venue
- European Journal of Cardio-Thoracic Surgery
- Publisher
- Oxford University Press (OUP)
- Published
- 2014-10-17
- Volume
- 48
- Issue
- 1
- Pages
- 91-97
- ISSN
- 1010-7940 (ISSN-L)
- 1873-734X
- OpenAlex
- W2330109333
- Cited by
- 61
- References
- 19
- Citations by year
- 2026: 4 · 2025: 4 · 2024: 12 · 2023: 4 · 2022: 2 · 2021: 7 · 2020: 10 · 2019: 7 · 2018: 4 · 2017: 2 · 2016: 4 · 2015: 1
- FWCI
- 1.76
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- European Journal of Cardio-Thoracic Surgery (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Academy of Finland
- 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, right ventricular outflow tract reconstruction, reoperation, late survival, two-stage repair, long-term prognosis, pediatric cardiac surgery
- MeSH terms
- Adolescent, Adult, Child, Child, Preschool, Female, Finland, Follow-Up Studies, Humans, Infant, Infant, Newborn, Male, Middle Aged, Pulmonary Valve, Reoperation, Risk Factors, Tetralogy of Fallot, Survival Analysis, Young Adult, Cardiac Valve Annuloplasty
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