Long-Term Results after Fallot Repair

Thorac Cardiovasc Surg. 2022 Dec;70(S 03):e7-e14. doi: 10.1055/s-0042-1749098. Epub 2022 Jun 25.


Background: The aim of this study was to evaluate the long-term outcome and freedom from pulmonary valve replacement (PVR) after initial repair of tetralogy of Fallot (TOF).

Patients and methods: The cohort of 306 patients treated between 1980 and 2017 was divided into anatomical subgroups according to the diagnosis of TOF-pulmonary stenosis, TOF-pulmonary atresia and TOF-double outlet right ventricle. Patients were treated with transannular patch (TAP), valve sparing repair (VSR), or conduits from the right ventricle to the pulmonary arteries (RVPA conduits).

Results: There were 21 deaths (6.9%), 14 being hospital deaths (4.6%) after primary correction and four deaths (1.3%) occurred after PVR. One patient died after a non-cardiac operation (0.3%). There were two late deaths (0.7%). During the past 12 years no early mortality has been observed. Ninety-one patients (30.4%) received PVR after a median of 12.1 ± 7.0 years with an early mortality of 4.4% (n = 4) and no late mortality. A significant difference in freedom from reoperation after TAP, VSR, and RVPA-conduits could be identified. Multivariate analysis displayed transannular repair (p = 0.016), primary palliation (p <0.001), the presence of major aortopulmonary collateral arteries (MAPCA; p = 0.023), and pulmonary valve Z-scores < - 4.0 (p = 0.040) as significant risk factors for PVR.

Conclusion: TOF repair has a beneficial long-term prognosis with low morbidity and mortality. Pulmonary valve Z-scores < - 4.0, transannular repair, and presence of MAPCAs are associated with earlier PVR. Non-VSRs and TOF-pulmonary atresia lead to earlier reoperation but have no negative impact on survival.

MeSH terms

  • Cardiac Surgical Procedures*
  • Humans
  • Infant
  • Pulmonary Atresia* / complications
  • Pulmonary Atresia* / surgery
  • Pulmonary Valve* / diagnostic imaging
  • Pulmonary Valve* / surgery
  • Reoperation
  • Retrospective Studies
  • Tetralogy of Fallot* / diagnostic imaging
  • Tetralogy of Fallot* / surgery
  • Treatment Outcome