An evaluation of surgical correction in tetralogy of Fallot. A study of 101 cases

INTRODUCTION: The optimal management of infants with tetralogy of Fallot continues to evolve. We review our series to evaluate the results. PATIENTS AND METHODS: From 1979 to 1992, 101 children with tetralogy of Fallot without pulmonary atresia, were operated on. Infundibular and valvar stenosis were present in 59 cases (58.4%), distal stenosis in 24 (23.7%) and trunk and/or branches hypoplasia in 14 (13.9%). Until 1985, symptomatic infants underwent palliative surgical techniques. Since then, we prefer early repair as elective treatment in all cases, using palliative techniques only in symptomatic infants with inadequate anatomy. Palliative techniques were used in 35 children (34.6%), mean age at surgery was 6.7 +/- 6.7 months; corrective surgery, after palliative technique, in 23 children (22.8%), mean age at surgery was 36.0 +/- 12.9 months and primary correction in 66 children (65.3%), mean age at surgery was 30.7 +/- 20.8 months. For 45 patients (44.6%) the right ventricular outflow tract obstruction was relieved by a transannular patch. RESULTS: Post-repair right ventricular-left ventricular pressure ratio is a usefull index to predict the short and long-term evolution of this cardiopathy. Thus, values were significantly smaller in children without postoperative cardiac failure (0.51 +/- 0.10 vs 0.59 +/- 0.15; p < 0.01), in the survivors (0.53 +/- 0.12 vs 0.72 +/- 0.13; p < 0.001) and in those with better functional status in the follow-up (0.52 +/- 0.12 vs 0.66 +/- 0.13; p < 0.001). Whole mortality was 13% for two-stage correction and 7.6% for primary correction. From 1985 mortality has reduced at 6.7 and 2.3% respectively. The follow-up was completed in 78 children with corrective surgery (96%), with a mean of 43.4 +/- 32.6 months. There were three later deaths. Actuarial survival at six years is 86%. CONCLUSION: We have proved that the optimal treatment in infants with tetralogy of Fallot and suitable size pulmonary vascular tree is the early primary repair. The pressure relation between both ventricles post-repair is a useful index for the outcome.