Abstract 14183: Adult Outcomes in Tetralogy of Fallot Repair With Pulmonary Annular Preserving Technique
Background: Tetralogy of Fallot (ToF) is the most common cyanotic congenital lesion. The original ToF repair involved patching the pulmonic annulus (TAP); resulting in chronic severe pulmonic regurgitation. To prevent pulmonary regurgitation and its late sequelae, the pulmonary annulus preserving technique (ToF-AP) was developed. Outcomes in the adult population with ToF-AP have yet to be characterized.
Methods: This was a retrospective study of all adults (birthdate 1982-1996) with childhood repair of ToF followed at our center. We excluded patients with ToF pulmonary atresia, atrioventricular canal defect, absent pulmonary valves, or conduit repair. The primary (composite) cardiac events of interest included death, ventricular arrhythmia, congestive heart failure or cerebrovascular accident. Secondary outcomes included atrial arrhythmia, pulmonary valve replacement (PVR), ventricular function, and exercise capacity. A log rank test was used to determine differences in the primary endpoint between adults with ToF-AP and TAP.
Results: A total of 206 adults were included; 94 with ToF-AP [25± 4years] and 112 with TAP [25±5 years]. The average age at primary repair was 30 months, and approximately 30% of patients in both groups had a previous palliative shunt. There was a trend toward less adverse cardiac events in ToF-AP vs TAP group (1% vs. 6%, p=0.075). There was 1 death in the ToF-AP and 2 in the TAP group. Atrial arrhythmias occurred in 4% ToF-AP vs. 7% of the TAP group (p=0.55). At last follow up, preserved right ventricular systolic function by echocardiography was more common in the ToF-AP vs. TAP group (50% vs 32%, p=0.008). There was no difference in maximal predicted VO2 between groups (69% ToF-AP vs. 65% TAP). Fewer patients with ToF-AP underwent PVR in adulthood compared to TAP. (11% vs. 39%, p<0.001). Similarly, over a lifetime, PVR was less common in patients with ToF-AP vs TAP (17% vs. 64%, p<0.001).
Conclusion: While most young adults with TOF do well, there is a subset of patients with complications. Cardiac complications in adults with ToF-AP are less frequent compared to those with TAP. Adults with ToF-AP are almost 4 times less likely to undergo PVR in childhood or early adulthood compared to patients with TAP.
Author Disclosures: R.A. Ducas: None. L. Harris: None. R. Wald: None. C. Kayedpour: None. G. Krishna Kumar Nair: None. E. Hickey: None. C. Silversides: None.
- © 2015 by American Heart Association, Inc.