title: Effect of transannular patching on outcome after repair of tetralogy of Fallot.
abstract: Among 814 patients undergoing repair of tetralogy of Fallot with pulmonary stenosis between 1967 and May 1986, transannular patching in the current era was a weak risk factor for death early postoperatively (predicted 30-day mortality, 4% with a transannular patch and 1.4% without) and is not a risk factor for instantaneous risk of death late postoperatively (predicted 20-year survival including early death, 94% with a transannular patch and 96.5% without). Ninety-six percent of surviving patients were in New York Heart Association functional class I at last follow-up, and the slight decline in this percentage as the interval between operation and last follow-up lengthened could have been due to chance alone (p = 0.24) and was no different in patients with a transannular patch. Transannular patching was a risk factor for reoperation for pulmonary regurgitation late postoperatively, but only a 7% incidence within 20 years is predicted when mild residual stenoses are beyond the patch: the incidence rises to about 20% with important distal stenoses. Inferences from the study are relevant to the indications for transannular patching and insertion of allograft semilunar valves at the time of repair.
authors.affiliation: Department of Surgery, University of Alabama, Birmingham School of Medicine and Medical Center 35294.
authors.forename: J K
authors.initials: JK
authors.lastname: Kirklin
authors.forename: J W
authors.initials: JW
authors.lastname: Kirklin
authors.forename: E H
authors.initials: EH
authors.lastname: Blackstone
authors.forename: A
authors.initials: A
authors.lastname: Milano
authors.forename: A D
authors.initials: AD
authors.lastname: Pacifico
mesh_terms: D002648:Child; D005500:Follow-Up Studies; D006801:Humans; D011184:Postoperative Period; D011664:Pulmonary Valve / Q000601:surgery*; D011666:Pulmonary Valve Stenosis / Q000601:surgery*; D012086:Reoperation; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D013771:Tetralogy of Fallot / Q000401:mortality / Q000601:surgery*; D013997:Time Factors