Abstract 15208: Long-Term Outcomes After Transatrial Repair of Tetralogy of Fallot: 25 Years Experience
Objective. Transatrial repair of Tetralogy of Fallot has been adopted in Melbourne since 1980. This review examines long-term outcomes of the technique emphasizing survival and reoperation.
Methods and Results. Records of 675 consecutive patients undergoing transatrial repair of tetralogy of Fallot from 1980 to 2005 were reviewed, their follow-up updated and survival confirmed from National death registries. Patients with pulmonary atresia, DORV or AVSD were excluded. A third (220/675 pts) had undergone previous palliation. Median age at repair was 2 years in the first 8 years, and remained steady at 1 year of age from 1988 onwards. Transannular incision was performed in 75% of cases and autologuous pericardium was the material used to patch the incision in majority of cases (89%). There were 7 hospital deaths (1%). Seven patients could not be traced. Nine patients died during follow-up (2 sudden and 7 non-cardiac deaths). Mean follow-up was 11.7 ± 6.3 years. Twenty-five years survival was 97% (95% CI: 95% to 98%). Twenty-five years freedom from first reoperation for dilatation of the right ventricle (RV), RV outflow tract obstruction (RVOTO) and pulmonary artery stenosis were respectively 87% (95% CI: 80% to 91%), 89% (95% CI: 86% to 92%), and 96 % (95% CI: 93% to 98%)(fig1). Younger age at repair and prior shunt were predictive of reoperation for RVOTO (respectively HR=0.67; p=0.042, and HR=3.0; p=0.001) and RV dilatation (HR=0.61; p=0.022, and HR=2.4; p=0.017). First postoperative gradient was strongly predictive of reoperation for RVOTO (HR=7.5; p<0.001).
Conclusion. During long-term follow-up, transatrial repair of tetralogy of Fallot was associated with minimal risk of sudden death and low rate of reintervention for RV dilatation. The technique is associated with low risk of early reintervention for residual outflow tract obstruction. Figure 1. Freedom from RVOT reoperation
- © 2012 by American Heart Association, Inc.