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J Am Coll Cardiol. 2014 Feb 18;63(6):563-8. doi: 10.1016/j.jacc.2013.10.011. Epub 2013 Oct 30.

Low risk of pulmonary valve implantation after a policy of transatrial repair of tetralogy of Fallot delayed beyond the neonatal period: the Melbourne experience over 25 years.

Author information

1
Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia; Department of Pediatrics of the University of Melbourne, and the Murdoch Children's Institute, Melbourne, Australia. Electronic address: yves.dudekem@rch.org.au.
2
Department of Clinical Epidemiology & Biostatistics Unit, Murdoch Children's Research Institute, Melbourne, Australia; Department of Mathematics and Statistics, La Trobe University, Melbourne, Australia.
3
Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia.
4
Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia; Department of Pediatrics of the University of Melbourne, and the Murdoch Children's Institute, Melbourne, Australia.
5
Department of Cardiology, Royal Children's Hospital, Melbourne, Australia.
6
Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia.
7
Department of Cardiology, Princess Margaret Hospital for Children, Perth, Australia.
8
Department of Cardiology, Women's & Children's Hospital, Adelaide, Australia.
9
Department of Cardiology, Monash Medical Centre, Clayton, Melbourne, Australia.

Abstract

OBJECTIVES:

The study sought to evaluate the late outcomes of a policy of transatrial repair delayed beyond the neonatal period.

BACKGROUND:

Long-term outcomes of transatrial repair of tetralogy of Fallot are unknown.

METHODS:

The records of 675 consecutive patients undergoing a transatrial repair of tetralogy of Fallot between 1980 and 2005 were reviewed, their follow-up updated and survival confirmed from national death registries. One-third (220 of 675) had undergone previous palliation. Median age at repair was 2 years in the first 8 years, and 1 year from 1988 onward. A transannular incision was performed in 75% of cases and autologous pericardium was the material used to patch this incision in 92% of cases.

RESULTS:

There were 7 hospital deaths (1%). Eight patients died during follow-up (2 sudden unexpected and 6 noncardiac deaths). Mean follow-up was 11.7 ± 6.3 years. Twenty-five years' survival was 97% (95% confidence interval [CI]: 95% to 98%). Twenty-five years' freedom from implantation of a valved conduit was 84.6% (95% CI: 77.8% to 89.5%). By multivariable analysis, prior palliation and younger age at repair were predictive of implantation of a valved conduit (hazard ratio: 2.4, 95% CI: 1.3 to 4.6, p = 0.008; hazard ratio: 0.70, 95% CI: 0.50 to 0.96, p = 0.03, respectively).

CONCLUSIONS:

During long-term follow-up, transatrial repair of tetralogy of Fallot was associated with a minimal risk of sudden death and low rate of reintervention for right ventricular dilation and residual outflow tract obstruction.

KEYWORDS:

cardiac surgery; congenital heart disease; long-term outcome; pulmonary valve; tetralogy of Fallot

PMID:
24513776
DOI:
10.1016/j.jacc.2013.10.011
[Indexed for MEDLINE]
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