title: Long-term outcome after total correction of tetralogy of Fallot in adolescent and adult age.
abstract: Although most patients with tetralogy of Fallot (TOF) undergo radical repair during infancy and childhood, patients remaining undiagnosed and untreated until adulthood can still be treated. These patients have either a previous palliative or natural collateral circulation to the lung or a mild form of right ventricular outflow tract (RVOT) obstruction. The aim of this study is to analyze the perioperative and long-term results of radical corrective procedures in patients who reached adult ages. Two hundred and seven patients with TOF underwent complete correction between 1985-and 2002, 64 (30.9%) of whom were aged 14 years or more. The mean age at corrective repair for this group was 20.6 +/- 7.5 years (range 14 to 49 years). Only two patients had previous modified Blalock-Taussig shunts. In 44 patients (68.7%) besides infundibular resection, a transannular gluteraldehyde-treated pericardial patch was used to reconstruct right ventricular outflow tract (RVOT). Only infundibular patching was used in 15 patients (23.4%) and infundibular muscular resection with primary closure of right ventricle was performed in five patients (7.8%). Hospital mortality was 3.1% with two patients. Four patients (6.2%) underwent reoperation because of recurrent ventricular septal defect (VSD) with/without residual obstruction or pulmonary regurgitation. All survivors were in NYHA class I (42) or II (17). Late mortality was recorded in two patients and 16-year actuarial survival was 89.2%+/- 4.9%. The significant negative predictors of late survival determined by univariate analysis were reoperation <0.018) and associated cardiac anomalies <0.011). Multivariate analysis showed that there was no negative predictor of late-term mortality. Corrective procedures in adult patients with TOF can be performed successfully compared to patients who underwent operation during infancy and childhood.
authors.affiliation: Department of Cardiovascular Surgery, Koşuyolu Heart and Research Hospital, Istanbul, Turkey. gulayhasan@superonline.com
authors.forename: Hasan Basri
authors.initials: HB
authors.lastname: Erdoğan
authors.forename: Nilgün
authors.initials: N
authors.lastname: Bozbuğa
authors.forename: Nihan
authors.initials: N
authors.lastname: Kayalar
authors.forename: Vedat
authors.initials: V
authors.lastname: Erentuğ
authors.forename: Suat Nail
authors.initials: SN
authors.lastname: Omeroğlu
authors.forename: Kaan
authors.initials: K
authors.lastname: Kirali
authors.forename: Gokhan
authors.initials: G
authors.lastname: Ipek
authors.forename: Esat
authors.initials: E
authors.lastname: Akinci
authors.forename: Cevat
authors.initials: C
authors.lastname: Yakut
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D006348:Cardiac Surgical Procedures; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015996:Survival Rate; D013771:Tetralogy of Fallot / Q000401:mortality / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D014694:Ventricular Outflow Obstruction / Q000601:surgery