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The Journal of Thoracic and Cardiovascular Surgery, Vol 89, 204-220, Copyright © 1985 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
HX Zhao, DC Miller, BA Reitz and NE Shumway
Early and late results in 309 patients undergoing repair of tetralogy of
Fallot between 1960 and 1982 were analyzed with respect to independent
determinants of operative mortality, late reoperation, and late death.
Follow-up extended to 22 years and totaled 2,743 patient- years. The
operative mortality rate was 4.9% +/- 1.3%. Multivariate logistic
regression analysis revealed that only young age, long cardiopulmonary
bypass time, and (probably) extent of right ventricular outflow tract patch
were independent significant determinants of operative mortality. Patients
who required a transannular right ventricular outflow tract patch and those
who underwent repair without any outflow tract patch were at higher risk
than those who received a separate right ventricular and/or pulmonary
artery patch. The long-term results were highly satisfactory: Only 15% +/-
3% of patients required reoperation 13 years postoperatively, and 85% +/-
4% of discharged patients were alive 16 years later. Time-dependent linear
stepwise multivariate discriminant analysis showed that extent of right
ventricular outflow tract patch (transannular greater than none greater
than right ventricular and/or [separate] pulmonary arterial), longer
ischemic arrest time, previous palliative shunt, and primary suture closure
of the ventricular septal defect were the only covariates that
independently portended a higher likelihood of reoperation. Similarly, only
older age, absence of hypoxic spells, and reoperation were significantly
and independently related to the probability of late death. The results of
these analyses demonstrate that intracardiac repair of tetralogy is a
durable procedure for upwards of 20 years; however, high-risk subsets of
patients can be identified in terms of operative mortality, reoperation,
and late death. Thus, there is still a need for improvement, particularly
future research devoted to better understanding of the electrophysiological
mechanisms responsible for arrhythmias, electrosurgical and medical
arrhythmia therapy, and right and left ventricular mechanics after repair
of tetralogy of Fallot.
ARTICLES
Surgical repair of tetralogy of Fallot. Long-term follow-up with particular emphasis on late death and reoperation
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