Abstract 1983: Tetralogy of Fallot Repair in Patients Older Than 40 Years
BACKGROUND. Few patients (pt) with tetralogy of Fallot (TOF) reach adulthood without complete repair. We sought to review our experience with complete surgical repair of TOF in pt over the age of forty years.
METHODS. Between 1970 and 2007; there were 52 TOF pt (30 men, 58 %) having first complete repair at age 50 ± 8 years (range: 40 – 68). Patients with double outlet right ventricle or TOF with pulmonary atresia were excluded. Presenting symptoms, data on previous palliative procedures, surgical reports and long-term outcome were analyzed.
RESULTS. Age at diagnosis was 29 ±19 years. 27 pt (52 %) had prior palliative surgery at 17 ±11 years including Blalock-Taussig shunt in 16 pt (one pt in combination with a Brock procedure), Brock procedure (5), Potts anastomosis (4); and pulmonary valvotomy (2). Preoperatively, O2 saturation was 86 ± 8 %. NYHA class III/IV was present in 40 pt (77 %), cyanosis in 35 pt (67 %) and coronary artery disease in 6 pt (12 %). Cardiac index was decreased in 21/35 pt (60 %). Surgery included pulmonary valve replacement (10 pt; 19 %) and a transannular patch (10 pt; 19 %); the native pulmonary valve was preserved in 32 pt (62 %). Early mortality (30 days) was 6 %; 3 pt died due to stroke, ventricular fibrillation, or cardiac tamponade. Long-term follow-up after 14.9 ± 9.3 years was feasible in 48 of 49 surgical survivors showing postoperative improvement in functional class in 42 of 48 pt (88 %). Only 6 pt remained in NYHA class III/IV (13 %). Reoperation was necessary in 7 pt (15 %): in 4 pt due to severe pulmonary regurgitation. Death occurred in 29 pt at age 66 ± 11 years (unknown in 18 pt, cardiac in 7 pt, other cause in 4 pt), age at death was lower in pt with previous palliation (59 ± 11 years versus 70 ± 12 years; p= 0.03). 10 year survival was less than expected compared to an age- and gender-matched population (73 % versus 91 % expected; p<0.01)
CONCLUSION. Complete repair of TOF is feasible in older patients but carries an increased operative risk. Surgical survivors have marked improvement in functional class, however survival remains less than expected. Reduced late survival and need for reoperation emphasize the importance of long-term informed follow-up.