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J Thorac Cardiovasc Surg 1999;118:245-251
© 1999 Mosby, Inc.

SURGERY FOR CONGENITAL CARDIOVASCULAR DISEASE

REOPERATION IN ADULTS WITH REPAIR OF TETRALOGY OF FALLOT: INDICATIONS AND OUTCOMES

Erwin N. Oechslin, MD, David A. Harrison, MD, Louise Harris, MD, Eugene Downar, MD, Gary D. Webb, MD, Samuel S. Siu, MD, William G. Williams, MD

Erwin Oechslin was supported by the Faculty of Medicine, University of Zurich, and the Stiefel Zangger Foundation, Zurich, Switzerland.

Address for reprints: William G. Williams, MD, Hospital for Sick Children, 555 University Ave, Toronto, ON M5G 1X8, Canada.

Objective: The purpose of this study is to review indications, surgical procedures, and outcomes in adults with repaired tetralogy of Fallot referred for reoperation.
Method: Sixty consecutive adults (age >= 18 years) who underwent reoperation between 1975 and 1997 after previous repair of tetralogy of Fallot were reviewed. Mean age at corrective repair was 13.3 ± 9.6 years and at reoperation 33.3 ± 9.6 years. Mean follow-up after reoperation is 5.0 ± 4.9 years.
Results: Long-term complications of the right ventricular outflow tract (n = 45, 75%) were the most common indications for reoperation: severe pulmonary regurgitation (n = 23, 38%) and conduit failure (n = 13, 22%) were most frequent. Less common indications were ventricular septal patch leak (n = 6) and severe tricuspid regurgitation (n = 3). A history of sustained ventricular tachycardia was present in 20 patients (33%) and supraventricular tachycardia occurred in 9 patients (15%). A bioprosthetic valve to reconstruct the right ventricular outflow tract was used in 42 patients. Additional procedures (n = 115) to correct other residual lesions were required in 46 patients (77%). There was no perioperative mortality. Actuarial 10-year survival is 92% ± 6%. At most recent follow-up, 93% of the patients are in New York Heart Association classification I or II. Sustained ventricular tachycardia occurred in 4 patients (7%) during follow-up.
Conclusions: Long-term complications of the right ventricular outflow tract were the main reason for reoperation. Mid-term survival and functional improvement after reoperation are excellent.




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