Long-Term Outcomes Of Surgical Treatment Of Tetralogy Of Fallot.

Introduction Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart defect. Objectives To evaluate long-term outcomes of patients who underwent complete repair of TOF at our institution and to compare the outcomes of patients with pulmonary valve- -sparing repair (annulus preserved) versus patients with a transannular patch. We also evaluated the rate of growth of the pulmonary valve annulus and pulmonary arteries. Materials and Methods Retrospective study of 142 consecutive children with TOF admitted between April 1998 and April 2019, excluding 4 patients who only had palliative surgery without posterior complete repair and 5 patients who received a right ventricle to main pulmonary artery (RV-PA) conduit with a pulmonary homograft. Patients were divided into two groups, according to the technique to relieve RVOT obstruction: Group 1 - pericardial transannular patch (79 patients) and Group 2 - valve-sparing technique and preserved annulus (54 patients). Pre and post-op echocardiographic measurements, surgical details, postoperative course, and reinterventions were registered. Results Mean age was 17±65.86 months (range 11days-22years) and mean weight was 10Kg (2.5-45Kg). Eleven patients had trisomy-21 and 3 had 22q11.2 deletion. Abnormal anatomic variations included coronary anomalies in 7 patients (LAD artery from RCA, crossing the infundibulum), and 5 without pulmonary valve. Twenty-six patients (18.8%) had previous systemic-to-pulmonary artery shunt (24 Blalock-Taussig, 1 Waterson, 1 Potts and 1 SANO). Pre-op peak gradient was 75.5±20.9mmHg (20-125mmHg). Ventricular infundibulectomy was carried out in all patients but seven who had abnormal coronary anatomy. Mean extracorporeal circulation (56.6±19.4min vs. 63.8±25.1min; p=0.092) and cross-clamp times (33.3±10.6min vs. 35.3±11.5min; p=0.311) were similar. During follow-up (mean 12.8±9.1years), a favourable evolution of the diameter of the annulus in the pulmonary valve-sparing patients was observed. Post-op pulmonary regurgitation was greater in Group 1 (2.8±1.0 vs. 1.9±1.1; p<0.001), as well the rate of reoperations with pulmonary homografts [18 (22.8%) vs. 3 (5.6%); p=0.04] and the rate of percutaneous pulmonary valve [5 (6.3%) vs. 0 (0%); p=0.4]. There was a decrease in RV-PA systolic gradients in both groups (to 24.6±10.5mmHg vs. 22.6±11.0mmHg; p=0.453). Almost all patients were in NYHA class I (1.0±0.2 vs. 1.0±0.1; p=0.723). There were no differences in late survival at 1, 10 and 25 years between the group 1 and 2 respectively (96.3±2.6% vs. 89.9±3.4%, 93.4±3.8% vs. 88.4±3.7%, and 85.1±6.6% vs. 88.4±3.7%; p<0.062). Conclusions Long-term outcomes after definitive repair of tetralogy of Fallot with preservation of the annulus were excellent with pulmonary artery growth, low incidence of postoperative complications, and low rate of reoperations.