1. Single-center 50 years' experience with surgical management of tetralogy of Fallot
- Author
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Egil Seem, Kjell Saatvedt, Harald Lindberg, Tom N. Hoel, and Sigurd Birkeland
- Subjects
Pulmonary and Respiratory Medicine ,Heart Defects, Congenital ,Reoperation ,medicine.medical_specialty ,Single Center ,medicine ,Humans ,In patient ,Surgical treatment ,Survival analysis ,Tetralogy of Fallot ,business.industry ,Norway ,Palliative Care ,Age Factors ,Infant ,General Medicine ,Prostheses and Implants ,medicine.disease ,Prognosis ,Survival Analysis ,Surgery ,Treatment Outcome ,Child, Preschool ,Cohort ,Transannular patch ,Cardiology and Cardiovascular Medicine ,Congenital cardiac malformations ,business ,Follow-Up Studies - Abstract
The aim of this study was to evaluate the long-term outcome of total repair for tetralogy of Fallot. We aimed to characterize late survival and the time-related risk of late reoperation.Operative protocols, patient records, and the database of the department were evaluated from 1951 until 2008. The official death registry of Norway was used for follow-up. Of the patients identified, the follow-up was 99.6% complete.A total of 627 patients were studied. Of these, 570 could be identified for follow-up. There were a total of 41 early and 30 late deaths. The total early (including palliative procedures) mortality was 7.2% and total late mortality was 7.9%. However, during the last 10 years, no early mortality has been observed following repair. A total of 264 patients underwent some form of palliative procedure as their first treatment, and 541 patients had a reparative procedure performed, with an early mortality of 31 (5.7%). In patients subjected to a reparative procedure, there was no difference in freedom from death or reoperation following primary repair versus primary palliation. The use of transannular patch was associated with a highly significant risk of reoperation.Surgical treatment of the tetralogy of Fallot and related congenital cardiac malformations has good long-term prognosis. In this cohort of patients, more than one-third required additional procedures later on, and, in some cases, as many as four additional surgeries. Palliative procedures followed by repair do not influence survival or reoperation-free survival. There are no differences between transatrial versus transventricular repair on survival or re-repair. Any transannular incision increases the risk of re-repair, but does not influence long-time survival. There is an almost linear decrease in reoperation-free survival following any type of repair of tetralogy of Fallot, even for as long as 50 years since the first procedure.
- Published
- 2010