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Mayo Clin Proc. 2010 Dec;85(12):1090-4. doi: 10.4065/mcp.2010.0286.

Tetralogy of fallot repair in patients 40 years or older.

Author information

1
Cardiovascular Center Zurich Klinik Im Park, Zurich, Switzerland.

Abstract

OBJECTIVE:

To report the outcomes of patients with tetralogy of Fallot (TOF) undergoing surgical repair at age 40 years or older.

PATIENTS AND METHODS:

We reviewed records of patients (age, ≥40 years) who underwent TOF repair from January 1, 1970, through December 31, 2007. Symptoms, palliative procedures, surgical reports, and long-term outcomes were analyzed.

RESULTS:

Fifty-two patients (30 men [58%]) had surgery at a mean ± SD age of 50±8 years; 27 (52%) had prior palliative surgery at a mean ± SD age of 17±11 years. Procedures for TOF repair included pulmonary valve replacement (n=10), transannular patch (n=10), and native pulmonary valve preservation (n=32). The 30-day mortality rate was 6% (stroke, n=2; ventricular fibrillation, n=1). A mean ± SD follow-up of 14.9±9.3 years was feasible in 48 of 49 survivors; improvement in functional class was observed in 42 patients. Reoperation was performed in 7 patients (4 for pulmonary regurgitation). Twenty-nine patients died (mean ± SD age, 65±12 years); causes of death were cardiac (n=7), noncardiac (n=4), and unknown (n=18). Mean ± SD age at death was younger in patients with previous palliation (59±11 years vs 70±12 years; P=.03). The 10-year survival rate was lower than expected compared with an age- and sex-matched population (73% vs 91%; P<.001).

CONCLUSION:

Complete repair of TOF in patients 40 years or older is feasible but carries increased operative risk. Surgical survivors have improvement in functional class; however, survival remains lower than expected. Reduced survival and need for reoperation emphasize the importance of pulmonary valve replacement at the time of initial repair and long-term follow-up.

PMID:
21123635
PMCID:
PMC2996156
DOI:
10.4065/mcp.2010.0286
[Indexed for MEDLINE]
Free PMC Article

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