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

J Am Coll Cardiol. 2014 Feb 18;63(6):563-8. doi: 10.1016/j.jacc.2013.10.011. Epub 2013 Oct 30.


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.

Keywords: cardiac surgery; congenital heart disease; long-term outcome; pulmonary valve; tetralogy of Fallot.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Cardiac Surgical Procedures / statistics & numerical data*
  • Child, Preschool
  • Cyanosis / therapy
  • Echocardiography
  • Female
  • Follow-Up Studies
  • Heart Valve Prosthesis Implantation / statistics & numerical data
  • Humans
  • Infant
  • Male
  • Palliative Care
  • Pulmonary Valve / surgery
  • Reoperation / statistics & numerical data
  • Retrospective Studies
  • Tetralogy of Fallot / diagnostic imaging
  • Tetralogy of Fallot / mortality
  • Tetralogy of Fallot / surgery*
  • Victoria / epidemiology