Tetralogy of Fallot: Influence of Surgical Technique on Survival and Reoperation Rate∗

Boening, Andreas; Scheewe, Jens; J, Paulsen; Regensburger, D.; Kramer, Hans‐Heiner; Hedderich, Jürgen; Cremer, J.

doi:10.1055/s-2001-19013

Cited by 12 publications

(7 citation statements)

References 4 publications

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“…Reoperations late after correction of tetralogy of Fallot are reported with variable incidence. Our results are comparable with the findings of Boening et al 6 and indicate that the surgical technique used in repairing tetralogy of Fallot, as for instance the use of transannular patch compared to preservation of pulmonary valve, does not influence the reoperation rate late after correction. However, when we excluded closure of isolated residual ventricular septal defect, the rate of reoperation was significantly decreased after repair with preservation of the pulmonary valve in comparison to repair with transannular patching.…”

Section: Discussionsupporting

confidence: 91%

Indications for reoperation late after correction of tetralogy of Fallot

et al. 2010

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Section: Discussionsupporting

confidence: 91%

Indications for reoperation late after correction of tetralogy of Fallot

et al. 2010

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“…Many studies found no difference in survival comparing TAP and VS procedures, 11,18,20,[32][33][34][36][37][38]40 which was likely in part associated with their limited sample-size or short follow-up. Recent larger studies have reported increased mortality for TAP compared with VS procedures.…”

Section: Survivalmentioning

confidence: 99%

Comparison of Long-term Outcomes of Valve-Sparing and Transannular Patch Procedures for Correction of Tetralogy of Fallot

et al. 2021

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IMPORTANCEThe choice of the right surgical technique for correction of tetralogy of Fallot (TOF) is contentious for patients with a moderate to severe right outflow tract obstruction. The use of a transannular patch (TAP) exposes patients to chronic pulmonary regurgitation, while valve-sparing (VS) procedures may incompletely relieve pulmonary obstruction.OBJECTIVE To compare 30-year outcomes of TOF repair after a VS procedure vs TAP. DESIGN, SETTING, AND PARTICIPANTSThis retrospective population-based cohort study was conducted among all patients with TOF born in the province of Quebec, Canada, from 1980 to 2015 who underwent complete surgical repair. Patients who received a TAP or VS procedure were matched using a propensity score based on preoperative factors in a 1:1 ratio. Data were analyzed from March 2020 through April 2021.EXPOSURES The study groups were individuals who received TAP and those who received VS. The VS group was further stratified by the presence of residual pulmonary stenosis. MAIN OUTCOMES AND MEASURESThe primary outcome was all-cause mortality, with 30-year survival evaluated using Cox proportional-hazards models. Secondary outcomes included the cumulative mean number of cardiovascular interventions, pulmonary valve replacements (PVRs), and cardiovascular hospitalizations were evaluated using marginal means/rates regressions. RESULTSAmong 683 patients with TOF (401 patients who underwent TAP [58.7%] and 282 patients who underwent a VS procedure [41.3%]), adequate propensity score matching was achieved for 528 patients (264 patients who underwent a VS procedure and 264 patients who underwent TAP). Among this study cohort, 307 individuals (58.1%) were men. The median (interquartile range [IQR]) follow-up was 16.0 (8.1-25.4) years, for a total of 8881 patient-years, including 63 individuals (11.9%) followed up for more than 30 years. Individuals who received a VS procedure had an increased 30-year survival of 99.1% compared with 90.4% for individuals who received TAP (hazard ratio [HR], 0.09 [95% CI, 0.02-0.41]; P = .002). Patients who underwent TAP had an increased 30-year cumulative mean number of cardiovascular interventions compared with patients who underwent a VS procedure without residual pulmonary stenosis (2.0 interventions [95% CI, 1.5-2.7 interventions] vs 0.7 interventions [95% CI, 0.5-1.1 interventions]; mean ratio [MR], 0.36 [95% CI, 0.25-0.50]; P < .001) and patients who underwent a VS procedure with at least moderate residual stenosis (1.3 interventions [95% CI, 0.9-1.9 interventions]; MR, 0.65 [0.45-0.93]; P = .02). Results were similar for PVR, with a 30-year cumulative mean 0.3 PVRs [95% CI, 0.1-0.7PVRs] for patients who underwent a VS procedure without residual pulmonary stenosis (MR, 0.22 [95% CI, 0.12-0.43]; P < .001) and 0.6 PVRs (95% CI, 0.2-1.5 PVRs) for patients with at least moderate residual stenosis (MR, 0.44 [95% CI, 0.21-0.93]; P = .03), compared with 1.4 PVRs (95% CI, (continued) Key Points Question Do valve-sparing (VS) operations have better long-term outcom...

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“…A small case-control study found a lower pulmonary valve replacement (PVR) rate following transatrial repair compared with transventricular repair. The use of a TAP is associated with a higher re-intervention rate 12, 54 , as is severity of ToF at repair 56, 65 . Specific indications for re-interventions will be discussed later in this article.…”

Section: Overall Survivalmentioning

confidence: 99%

Current outcomes and treatment of tetralogy of Fallot

et al. 2019

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Tetralogy of Fallot (ToF) is the most common type of cyanotic congenital heart disease. Since the first surgical repair in 1954, treatment has continuously improved. The treatment strategies currently used in the treatment of ToF result in excellent long-term survival (30 year survival ranges from 68.5% to 90.5%). However, residual problems such as right ventricular outflow tract obstruction, pulmonary regurgitation, and (ventricular) arrhythmia are common and often require re-interventions. Right ventricular dysfunction can be seen following longstanding pulmonary regurgitation and/or stenosis. Performing pulmonary valve replacement or relief of pulmonary stenosis before irreversible right ventricular dysfunction occurs is important, but determining the optimal timing of pulmonary valve replacement is challenging for several reasons. The biological mechanisms underlying dysfunction of the right ventricle as seen in longstanding pulmonary regurgitation are poorly understood. Different methods of assessing the right ventricle are used to predict impending dysfunction. The atrioventricular, ventriculo-arterial and interventricular interactions of the right ventricle play an important role in right ventricle performance, but are not fully elucidated. In this review we present a brief overview of the history of ToF, describe the treatment strategies currently used, and outline the long-term survival, residual lesions, and re-interventions following repair. We discuss important remaining challenges and present the current state of the art regarding these challenges.

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Tetralogy of Fallot: Influence of Surgical Technique on Survival and Reoperation Rate∗

Abstract: In our series of TOF patients operated over a period of 25 years, we were unable to assess an influence of the surgical technique used for definite correction on mortality or reoperation rate. Pulmonary atresia in patients with TOF is associated with a higher risk of death and reoperation.

Cited by 12 publications

References 4 publications

Indications for reoperation late after correction of tetralogy of Fallot

Indications for reoperation late after correction of tetralogy of Fallot

Comparison of Long-term Outcomes of Valve-Sparing and Transannular Patch Procedures for Correction of Tetralogy of Fallot

Current outcomes and treatment of tetralogy of Fallot

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