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THE JOURNAL OF CARDIOVASCULAR SURGERY
Rivista di Chirurgia Cardiaca, Vascolare e Toracica
Indexed/Abstracted in: BIOSIS Previews, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
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ORIGINAL ARTICLES CARDIAC SECTION
The Journal of Cardiovascular Surgery 2006 Febbraio;47(1):65-70
Outcome after one-stage repair of tetralogy of Fallot
Lee C., Lee C.-H., Kim S.-C., Lim C., Chang Y. H., Kang C. H., Jo W. M., Kim W.-H.
1 Department of Cardiovascular Surgery Sejong General Hospital, Sejong Heart Institute Bucheon, Kyungki-do, South Korea
2 Department of Thoracic and Cardiovascular Surgery Seoul National University Bundang Hospital Sungnam-shi, Kyungki-do, South Korea
3 Department of Thoracic and Cardiovascular Surgery Seoul National University Children's Hospital Seoul National University College of Medicine Seoul, South Korea
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.