title: Tetralogy of Fallot: transannular and right ventricular patching equally affect late functional status.
abstract: BACKGROUND
  In tetralogy of Fallot, transannular patching is suspected to be responsible for late right ventricular dilatation.
  
  
  RESULTS
  In our institution, 191 patients survived a tetralogy of Fallot repair between 1964 and 1984. Transannular patching was used in 99 patients (52%), patch closure of a right ventriculotomy in 35, and direct closure of a right ventriculotomy in 55. Two had a transatrial-transpulmonary approach. To identify predictive factors of adverse long-term outcome related to right ventricular dilatation, the following events were investigated: cardiac death, reoperation for symptomatic right ventricular dilatation, and NYHA class II or III by Cox regression analysis. Mean follow-up reached 22+/-5 years. The 30-year survival was 86+/-5%. Right ventricular patching, whether transannular or not, was the most significant independent predictor of late adverse event (improvement chi(2)=16.6, P:<0.001). In patients who had direct closure, the ratio between end-diastolic right and left ventricular dimensions on echocardiography was smaller (0.61+/-0.017 versus 0. 75+/-0.23, P:=0.007), with a smaller proportion presenting severe pulmonary insufficiency (9% versus 40%, P:=0.005). There was no difference between right ventricular and transannular patching concerning late outcome (log rank P: value=0.6), right ventricular size (0.70+/-0.28 versus 0.76+/-0.26, P:=0.4), or incidence of severe pulmonary insufficiency (30% versus 43%, P:=0.3).
  
  
  CONCLUSIONS
  In tetralogy of Fallot, transannular patching does not result in a worse late functional outcome than patching of an incision limited to the right ventricle. Both are responsible for a similar degree of long-term pulmonary insufficiency and right ventricular dilatation.
authors.affiliation: Division of Cardiovascular Surgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
authors.forename: Y
authors.initials: Y
authors.lastname: d'Udekem
authors.forename: C
authors.initials: C
authors.lastname: Ovaert
authors.forename: F
authors.initials: F
authors.lastname: Grandjean
authors.forename: V
authors.initials: V
authors.lastname: Gerin
authors.forename: M
authors.initials: M
authors.lastname: Cailteux
authors.forename: P
authors.initials: P
authors.lastname: Shango-Lody
authors.forename: A
authors.initials: A
authors.lastname: Vliers
authors.forename: T
authors.initials: T
authors.lastname: Sluysmans
authors.forename: A
authors.initials: A
authors.lastname: Robert
authors.forename: J
authors.initials: J
authors.lastname: Rubay
mesh_terms: D000293:Adolescent; D000328:Adult; D013504:Cardiovascular Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D002648:Child; D002675:Child, Preschool; D016757:Death, Sudden, Cardiac / Q000453:epidemiology; D004108:Dilatation, Pathologic / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011665:Pulmonary Valve Insufficiency / Q000000981:diagnostic imaging / Q000453:epidemiology; D012086:Reoperation / Q000706:statistics & numerical data; D015996:Survival Rate; D013771:Tetralogy of Fallot / Q000601:surgery*; D013995:Time; D016896:Treatment Outcome; D018497:Ventricular Dysfunction, Right / Q000209:etiology*