title: Long-term results after early primary repair of tetralogy of Fallot.
abstract: OBJECTIVE
  Early primary repair of tetralogy of Fallot has been routinely performed at Children's Hospital, Boston, since 1972. We evaluated the long-term outcome of this treatment strategy including the influence of a transannular patch.
  
  
  METHODS
  Fifty-seven patients less than 24 months of age (median 8 months) underwent primary repair of tetralogy of Fallot between January 1972 and December 1977. Thirty-one patients had a transannular patch. Survival and freedom from reintervention were determined by the Kaplan-Meier method with 95% confidence intervals.
  
  
  RESULTS
  There were 8 early deaths, and 1 patient died 24 years after initial repair. Recent follow-up was obtained for 45 of the 49 long-term survivors (92%). Median follow-up was 23.5 years. Ten patients underwent reintervention, 8 of whom underwent relief of right ventricular outflow tract obstruction. Right ventricular outflow tract obstruction occurred in 6 patients without a transannular patch and 2 with a transannular patch (33% vs 6%, P =.04). One pulmonary valve replacement was performed at another institution 20 years after the repair. Forty-one long-term survivors were in New York Heart Association class I and 4 were in class II. Actuarial survival was 86% at 20 years (95% confidence intervals = 80%-92%). Freedom from reintervention was 93% at 5 years (95% confidence intervals = 87%-99%) and 79% at 20 years (95% confidence intervals = 70%-86%). No significant differences were found between patients with and without a transannular patch (survival, P =.34; freedom from reintervention, P =.09, log-rank tests).
  
  
  CONCLUSIONS
  Long-term survival is excellent and the freedom from reintervention is satisfactory after early primary repair of tetralogy of Fallot in the 1970s. Use of a transannular patch does not reduce late survival and is associated with a lower incidence of right ventricular outflow tract obstruction.
authors: Department of Cardiac Surgery, Children's Hospital, Harvard Medical School, Boston, MA, USA.
authors: E A
authors: EA
authors: Bacha
authors: A M
authors: AM
authors: Scheule
authors: D
authors: D
authors: Zurakowski
authors: L C
authors: LC
authors: Erickson
authors: J
authors: J
authors: Hung
authors: P
authors: P
authors: Lang
authors: J E
authors: JE
authors: Mayer
authors: P J
authors: PJ
authors: del Nido
authors: R A
authors: RA
authors: Jonas
mesh_terms: D017079:Exercise Tolerance; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D016016:Proportional Hazards Models; D019736:Prostheses and Implants; D012086:Reoperation; D012189:Retrospective Studies; D013771:Tetralogy of Fallot / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome