Surgical repair of tetralogy of Fallot. Long-term follow-up with particular emphasis on late death and reoperation

Abstract

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.