Outcome after one-stage repair of tetralogy of Fallot.
OBJECTIVE
The purpose of this study was to evaluate the outcome after one-stage repair of tetralogy of Fallot (TOF).


METHODS
Between May 1997 and December 2002, 240 patients with a median age of 9 months (1 month-48 years) underwent one-stage repair of TOF. Closure of ventricular septal defect (VSD) was accomplished through the right atrium in 171 (71.3%) patients and through the right ventricle in 69 (28.7%) patients. For the reconstruction of the right ventricular outflow tract (RVOT), transannular repair was performed in 151 (62.9%) patients, and non-transannular repair was performed in 89 (37.1%) patients. Follow-up was complete, averaging 40+/-17.6 months (3 months-5.8 years).


RESULTS
There were 2 (0.8%) operative deaths. Between early repair group (age under 6 months) and late repair group (age above 6 months), there were no differences in the method of RVOT reconstruction (transannular vs non-transannular) and the need for branch pulmonary artery angioplasty. Early repair group had more transventricular VSD closure than late repair group (46% vs 22%, P < 0.05). Duration of inotropic support and intensive care unit (ICU) stay were longer in the early repair group (P < 0.05). Five patients required reoperations due to RVOT obstruction (n = 3), and residual VSD (n = 2). Kaplan-Meier freedom from reoperation at 5 years was 98.3+/-1%. Nine patients underwent catheter intervention for branch pulmonary artery stenosis. Freedom from reintervention at 5 years was 95.4+/-1.5%. All survivors are currently asymptomatic.


CONCLUSIONS
One-stage repair of TOF could be performed with low mortality and morbidity. Especially, early one-stage repair in symptomatic infant could be performed with low risk, eliminating the need for palliative procedures.
Lee
C
C
Department of Cardiovascular Surgery, Sejong General Hospital, Sejong Heart Institute, Bucheon, Kyungki-do, South Korea.
Lee
C N
CN
Kim
S C
SC
Lim
C
C
Chang
Y H
YH
Kang
C H
CH
Jo
W M
WM
Kim
W H
WH
D000015:Abnormalities, Multiple / Q000453:epidemiology; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D006348:Cardiac Surgical Procedures; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D013771:Tetralogy of Fallot / Q000453:epidemiology / Q000601:surgery*; D016896:Treatment Outcome