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J Thorac Cardiovasc Surg 2001;122:154-161
© 2001 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease (CHD)

Long-term results after early primary repair of tetralogy of Fallot

From the Departments of Cardiac Surgery,^a Biostatistics,^b and Cardiology,^c Children's Hospital, Harvard Medical School, Boston, Mass.

Received for publication May 4, 2000. Revisions requested June 20, 2000; revisions received Jan 22, 2001. Accepted for publication Feb 16, 2001. Address for reprints: Richard A. Jonas, MD, Department of Cardiac Surgery, Children's Hospital, Bader 2, 300 Longwood Ave, Boston, MA 02115. (E-mail: richard.jonas@ tch.harvard.edu).

Abstract

Objective: Early primary repair of tetralogy of Fallot has been routinely performed at Children's Hospital, Boston, since 1972. We evaluated the long-term outcome of this treatment strategy including the influence of a transannular patch.
Methods: Fifty-seven patients less than 24 months of age (median 8 months) underwent primary repair of tetralogy of Fallot between January 1972 and December 1977. Thirty-one patients had a transannular patch. Survival and freedom from reintervention were determined by the Kaplan-Meier method with 95% confidence intervals.
Results: There were 8 early deaths, and 1 patient died 24 years after initial repair. Recent follow-up was obtained for 45 of the 49 long-term survivors (92%). Median follow-up was 23.5 years. Ten patients underwent reintervention, 8 of whom underwent relief of right ventricular outflow tract obstruction. Right ventricular outflow tract obstruction occurred in 6 patients without a transannular patch and 2 with a transannular patch (33% vs 6%, P = .04). One pulmonary valve replacement was performed at another institution 20 years after the repair. Forty-one long-term survivors were in New York Heart Association class I and 4 were in class II. Actuarial survival was 86% at 20 years (95% confidence intervals = 80%-92%). Freedom from reintervention was 93% at 5 years (95% confidence intervals = 87%-99%) and 79% at 20 years (95% confidence intervals = 70%-86%). No significant differences were found between patients with and without a transannular patch (survival, P = .34; freedom from reintervention, P = .09, log-rank tests).
Conclusions: Long-term survival is excellent and the freedom from reintervention is satisfactory after early primary repair of tetralogy of Fallot in the 1970s. Use of a transannular patch does not reduce late survival and is associated with a lower incidence of right ventricular outflow tract obstruction.

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