The Fourth Decade After Repair of Tetralogy of Fallot: Taking Aim at Moving Targets
This year marks the 60th year since the first successful intracardiac repair of tetralogy of Fallot (TOF).1 The repair, largely unchanged over decades, consists of VSD closure and the relief of variable forms of right ventricular (RV) obstruction, usually with a trans-annular patch (TAP), and usually resulting in free pulmonary insufficiency (PI). Early in the experience with TOF repair, attention was on quantity of life - lifting the early dip in the survival curve. Palliative shunts were widely used, to permit repair at a safer, older age. The dividends from a full relief of obstruction included excellent function for decades for patients formerly suffering morbid or lethal disease. In this issue of Circulation, Cuypers and colleagues report findings of the third decennial follow up of a cohort of early TOF repairs, the longest prospective study of this population to date.2 As such longitudinal evidence accrues, we are continually called upon to reexamine both ends of the treatment timeline, though it is a wobbly yardstick that attempts to inform today's best practices by measuring the sequelae of yesterday's.
- Received October 17, 2014.
- Accepted October 20, 2014.