Total correction of tetralogy of fallot in adults: surgical results and long-term follow-up.
From 1962 to 1983, 117 patients between the ages of 16 and 72 years (mean, 25 years) underwent total correction of tetralogy of Fallot. All patients were operated on because of recent deterioration. Eighty (68%) had had previous surgical palliation. Complications occurred in 38 cases (32%) before total correction and were more frequent in older patients. The hospital mortality was 7.8% and was highest in older patients and those with a previous Potts shunt. Fifty-nine patients were followed up for as long as 23 years (mean, 9.2 years) after total correction. The probability of survival at 5, 10, and 15 years after total correction was 96%, 96%, and 84%, respectively. The actuarial freedom from any significant cardiovascular event at 5, 10, and 15 years was 84%, 73%, and 50%, respectively. Reoperation was required in ten cases (17%), in which there was one operative death. Late death occurred in four cases (6.8%). Left ventricular dysfunction was documented in ten patients (17%), three of whom had mural thrombi and two of whom had cerebrovascular accidents. A significant rhythm disorder was present in 13 patients. Fifty-four of the 55 surviving patients were in New York Heart Association (NYHA) functional class I or II at last follow-up. We conclude that 1) total correction of tetralogy of Fallot in adults is associated with a low operative mortality, similar to that in children, and offers symptomatic relief in most cases; 2) the long-term survival is excellent, but late sequelae become more frequent at late follow-up; 3) "corrective" reoperation can be done with a low risk; and 4) most of the survivors are in NYHA functional class I or II and lead normal, productive lives.
Park
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Department of Cardiology, Texas Heart Institute of St. Luke's Episcopal Hospital, Houston, Texas, USA.
Leachman
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RD
Cooley
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DA