Outcomes in Young Adults With Tetralogy of Fallot and Pulmonary Annular Preserving or Transannular Patch Repairs

Can J Cardiol. 2021 Feb;37(2):206-214. doi: 10.1016/j.cjca.2020.04.014. Epub 2020 Apr 21.


Background: Early surgical tetralogy of Fallot (ToF) repair involved patching across the pulmonic annulus (transannular patch [TAP] repair), which resulted in severe pulmonic regurgitation. Long-term outcome improvements were anticipated with modifications that preserved the pulmonic annulus (annulus-preserving [AP] repair). The objective of the present study was to evaluate the need for late reintervention in adults with AP repair and those with TAP repair.

Methods: We conducted a retrospective review of adults (born 1981-1996) with childhood intracardiac ToF repairs at a tertiary care center. The primary cardiovascular outcome was need for reintervention after primary intracardiac repair of ToF. Secondary outcomes included a composite of death, heart failure, and ventricular arrhythmias.

Results: Two hundred thirty adults were included: 104 with AP repair and 126 with TAP repair. The median age at last follow up was 25 years (interquartile range [IQR] 20-28) and the median follow-up duration was 7.9 years (IQR 3.5-12). Reintervention of any type was significantly more common in the TAP group during both childhood and adulthood (72.2% TAP vs 20.2% AP, HR 5.5, 95% CI 3.4-9.0; P < 0.001). Pulmonary valve replacement (PVR) was almost 6 times more likely in adults with TAP repair (65.1% TAP vs 16.3% AP, HR 5.7, 95% CI 3.4-9.7; P < 0.001).

Conclusions: Patients who had AP ToF repair had significantly fewer late reinterventions compared with TAP repair, with the majority of reinterventions due to PVR. More long-term follow-up is required.

MeSH terms

  • Adult
  • Canada / epidemiology
  • Cardiac Surgical Procedures / methods
  • Cardiac Surgical Procedures / statistics & numerical data
  • Cardiac Valve Annuloplasty* / adverse effects
  • Cardiac Valve Annuloplasty* / methods
  • Female
  • Humans
  • Long Term Adverse Effects* / diagnosis
  • Long Term Adverse Effects* / etiology
  • Long Term Adverse Effects* / physiopathology
  • Long Term Adverse Effects* / surgery
  • Male
  • Outcome and Process Assessment, Health Care
  • Pulmonary Valve Insufficiency* / diagnosis
  • Pulmonary Valve Insufficiency* / etiology
  • Pulmonary Valve Insufficiency* / surgery
  • Pulmonary Valve* / abnormalities
  • Pulmonary Valve* / physiopathology
  • Pulmonary Valve* / surgery
  • Reoperation* / methods
  • Reoperation* / statistics & numerical data
  • Retrospective Studies
  • Tetralogy of Fallot / surgery*