title: Reoperation in adults with repair of tetralogy of fallot: indications and outcomes.
abstract: OBJECTIVE
  The purpose of this study is to review indications, surgical procedures, and outcomes in adults with repaired tetralogy of Fallot referred for reoperation.
  
  
  METHODS
  Sixty consecutive adults (age >/= 18 years) who underwent reoperation between 1975 and 1997 after previous repair of tetralogy of Fallot were reviewed. Mean age at corrective repair was 13.3 +/- 9.6 years and at reoperation 33.3 +/- 9.6 years. Mean follow-up after reoperation is 5.0 +/- 4.9 years.
  
  
  RESULTS
  Long-term complications of the right ventricular outflow tract (n = 45, 75%) were the most common indications for reoperation: severe pulmonary regurgitation (n = 23, 38%) and conduit failure (n = 13, 22%) were most frequent. Less common indications were ventricular septal patch leak (n = 6) and severe tricuspid regurgitation (n = 3). A history of sustained ventricular tachycardia was present in 20 patients (33%) and supraventricular tachycardia occurred in 9 patients (15%). A bioprosthetic valve to reconstruct the right ventricular outflow tract was used in 42 patients. Additional procedures (n = 115) to correct other residual lesions were required in 46 patients (77%). There was no perioperative mortality. Actuarial 10-year survival is 92% +/- 6%. At most recent follow-up, 93% of the patients are in New York Heart Association classification I or II. Sustained ventricular tachycardia occurred in 4 patients (7%) during follow-up.
  
  
  CONCLUSIONS
  Long-term complications of the right ventricular outflow tract were the main reason for reoperation. Mid-term survival and functional improvement after reoperation are excellent.
authors.affiliation: Toronto Congenital Cardiac Centre for Adults, The Toronto Hospital, Ontario, Canada.
authors.forename: E N
authors.initials: EN
authors.lastname: Oechslin
authors.forename: D A
authors.initials: DA
authors.lastname: Harrison
authors.forename: L
authors.initials: L
authors.lastname: Harris
authors.forename: E
authors.initials: E
authors.lastname: Downar
authors.forename: G D
authors.initials: GD
authors.lastname: Webb
authors.forename: S S
authors.initials: SS
authors.lastname: Siu
authors.forename: W G
authors.initials: WG
authors.lastname: Williams
mesh_terms: D000293:Adolescent; D000328:Adult; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D003452:Cryosurgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D011665:Pulmonary Valve Insufficiency / Q000209:etiology / Q000401:mortality / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D015996:Survival Rate; D013610:Tachycardia / Q000209:etiology / Q000401:mortality / Q000601:surgery; D013771:Tetralogy of Fallot / Q000601:surgery*; D016896:Treatment Outcome; D014694:Ventricular Outflow Obstruction / Q000209:etiology / Q000401:mortality / Q000601:surgery