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- Title
The role of primary surgical repair technique on late outcomes of Tetralogy of Fallot: a multicentre study.
- Authors
Padalino, Massimo A; Pradegan, Nicola; Azzolina, Danila; Galletti, Lorenzo; Napoleone, Carlo Pace; Agati, Salvatore; Palma, Gaetano; Marianeschi, Stefano Maria; Seddio, Francesco; Cascarano, Maria Teresa; Carro, Cristina; Gregori, Dario; Vida, Vladimiro Lorenzo; Stellin, Giovanni
- Abstract
Open in new tab Download slide Open in new tab Download slide OBJECTIVES Repair of Tetralogy of Fallot (TOF) has currently excellent results with either transventricular or transatrial approach. However, it is unclear as to which has better late outcomes and what role of residual pulmonary valve (PV) regurgitation in the long term is. We report on late clinical outcomes after repair in a large series of patients with TOF, focusing on the type of surgical technique. METHODS This analysis is a retrospective multicentre study on patients undergoing TOF repair in infancy. The exclusion criteria of the study were TOF with pulmonary atresia or absent PV. RESULTS We selected 720 patients who had undergone TOF repair (median age 5.7 months, interquartile range 3.7–11.7). Preoperative cyanotic spells occurred in 18%. A transatrial repair was performed in 433 (60.1%) patients. The PV was preserved in 249 (35%) patients, while the right ventricular outflow tract was reconstructed with a transannular patch (60.4%) or a conduit (4.6%) in the rest of the patients. At a median follow-up of 4 years (range 1–21, 86% complete), 10 (1.6%) patients died, while 39 (6.3%) patients required surgical reoperation and 72 (11.7%) patients required an interventional procedure. The propensity match analysis showed that the incidence of postoperative complications and adverse events at follow-up were significantly increased in patients undergoing transventricular approach repair with transannular patch (P = 0.006) and PV preservation was a significant protective factor against postoperative complications (P = 0.009, odds ratio 0.5) and late adverse events (P = 0.022). CONCLUSIONS Surgical repair of TOF in infancy is a safe procedure, with good late clinical outcomes. However, transatrial approach and PV preservation at repair are associated with lower early and late morbidity.
- Subjects
TETRALOGY of Fallot; OPERATIVE surgery; PULMONARY valve; PULMONARY atresia; SURGICAL complications
- Publication
European Journal of Cardio-Thoracic Surgery, 2020, Vol 57, Issue 3, p565
- ISSN
1010-7940
- Publication type
Article
- DOI
10.1093/ejcts/ezz270