Low Risk of Pulmonary Valve Implantation After a Policy of Transatrial Repair of Tetralogy of Fallot Delayed Beyond the Neonatal Period : The Melbourne Experience Over 25 Years

Yves d'Udekem, John Galati, Glenda Rolley, Igor Konstantinov, Robert Weintraub, Leeanne Grigg, James Ramsay, Gavin Wheaton, Sarah Hope, Michael Cheung, Christian Brizard

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    Abstract

    Objectives The study sought to evaluate the late outcomes of a policy of transatrial repair delayed beyond the neonatal period. Background Long-term outcomes of transatrial repair of tetralogy of Fallot are unknown. Methods The records of 675 consecutive patients undergoing a transatrial repair of tetralogy of Fallot between 1980 and 2005 were reviewed, their follow-up updated and survival confirmed from national death registries. One-third (220 of 675) had undergone previous palliation. Median age at repair was 2 years in the first 8 years, and 1 year from 1988 onward. A transannular incision was performed in 75% of cases and autologous pericardium was the material used to patch this incision in 92% of cases. Results There were 7 hospital deaths (1%). Eight patients died during follow-up (2 sudden unexpected and 6 noncardiac deaths). Mean follow-up was 11.7 ± 6.3 years. Twenty-five years' survival was 97% (95% confidence interval [CI]: 95% to 98%). Twenty-five years' freedom from implantation of a valved conduit was 84.6% (95% CI: 77.8% to 89.5%). By multivariable analysis, prior palliation and younger age at repair were predictive of implantation of a valved conduit (hazard ratio: 2.4, 95% CI: 1.3 to 4.6, p = 0.008; hazard ratio: 0.70, 95% CI: 0.50 to 0.96, p = 0.03, respectively). Conclusions During long-term follow-up, transatrial repair of tetralogy of Fallot was associated with a minimal risk of sudden death and low rate of reintervention for right ventricular dilation and residual outflow tract obstruction.

    Original languageEnglish
    Pages (from-to)563-568
    Number of pages6
    JournalJournal of The American College of Cardiology
    Volume63
    Issue number6
    DOIs
    Publication statusPublished - 2014

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