Long-term outcomes of transatrial–transpulmonary repair of tetralogy of Fallot
2015
OBJECTIVES: The surgical approach to repair of tetralogy of Fallot (ToF) has shifted over the years. We aimed to report the long-term follow-up after ToF repair with the transatrial–transpulmonary approach and to determine predictors of long-term outcomes. METHODS: Retrospective analysis of patients operated on in two tertiary referral centres. Primary outcome measures were: death, pulmonary valve replacement (PVR), reintervention for other reasons, internal cardiodefibrillator and/or pacemaker placement. Kaplan– Meier assessment of overall and event-free survival as well as uni- and multivariate analyses of risk factors for outcomes were performed. RESULTS: Four hundred and fifty-three patients were included. Median age at operation was: 0.6 years (range 0–19.6) and median age at the last follow-up was 14.3 years (range 0.1–42.1). Median age at repair decreased from 1.2 years (range 0.6–5.8) (1970–80) to 0.3 years (range 0–4.7) (2000–12). A transannular patch (TP) was used in 65% of all patients. The use of a TP showed a decline from 89% in the initial years of the cohort to 64% in 2000–12. Early mortality was 1.1% (5 patients) for the entire cohort and late mortality 2.4% (11 patients). Overall survival for the entire cohort was 97.3% (95% CI 95.7–98.8) and 91.8% (95% CI 85.9–97.7) at 10 and 25 years, respectively. For patients with a TP (n= 294) vs non-TP (n= 159), this was 97.2% (95% CI 95.2–99.2) vs 97.5% (95% CI 95.1–99.9) at 10-year and 91.0% (95% CI 83.9–98.1) vs 96.3% (95% CI 93.0–99.6) at 25-year follow-up (P= 0.958). Fifty-two patients underwent PVR, and in 5 a pacemaker was inserted. Event-free survival for TP versus non-TP patients was 80.2% (95 CI% 75.5–84.9) vs 81.7% (95% CI 75.2–88.2) at 10-year and 27.9% (95% CI 17.7–38.1) vs 78.5% (95% CI 71.4–85.6) at 25-year follow-up (P= 0.016). In multivariate analysis, both the use of a TP (HR 1.705, 95% CI 1.023–2.842) and the year of surgical repair of tetralogy of Fallot (HR 1.039, 95% CI 1.006–1.073) were associated with a higher probability of an event. CONCLUSIONS: ToF patients corrected with the transatrial–transpulmonary approach have good long-term survival. PVR is a frequent event at longer follow-up, and other events are limited. The use of a TP is a predictor for poorer event-free outcomes, increasing the risk of the composite endpoint 1.7 times.
Keywords:
- Correction
- Source
- Cite
- Save
- Machine Reading By IdeaReader
25
References
40
Citations
NaN
KQI