Outcome after one-stage repair of tetralogy of Fallot

Abstract

Aim. The purpose of this study was to evaluate the outcome after one-stage repair of tetralogy of Fallot (TOF). Methods. Between May 1997 and December 2002, 240 patients with a median age of 9 months (1 month-48 years) underwent one-stage repair of TOF. Closure of ventricular septal defect (VSD) was accomplished through the right atrium in 171 (71.3%) patients and through the right ventricle in 69 (28.7%) patients. For the reconstruction of the right ventricular outflow tract (RVOT), transannular repair was performed in 151 (62.9%) patients, and non-transannular repair was performed in 89 (37.1%) patients. Follow-up was complete, averaging 40±17.6 months (3 months-5.8 years). Results. There were 2 (0.8%) operative deaths. Between early repair group (age under 6 months) and late repair group (age above 6 months), there were no differences in the method of RVOT reconstruction (transannular vs non-transannular) and the need for branch pulmonary artery angioplasty. Early repair group had more transventricular VSD closure than late repair group (46% vs 22%, P<0.05). Duration of inotropic support and intensive care unit (ICU) stay were longer in the early repair group (P<0.05). Five patients required reoperations due to RVOT obstruction (n=3), and residual VSD (n=2). Kaplan-Meier freedom from reoperation at 5 years was 98.3±1%. Nine patients underwent catheter intervention for branch pulmonary artery stenosis. Freedom from reintervention at 5 years was 95.4±1.5%. All survivors are currently asymptomatic. Conclusion. One-stage repair of TOF could be performed with low mortality and morbidity. Especially, early one-stage repair in symptomatic infant could be performed with low risk, eliminating the need for palliative procedures.