title: Transannular patching is a valid alternative for tetralogy of Fallot and complete atrioventricular septal defect repair.
abstract: OBJECTIVE
  We report our experience with repair of tetralogy of Fallot associated with complete atrioventricular septal defect, addressing in particular the need for a pulmonary valve in the right ventricular outflow tract.
  
  
  METHODS
  Between 1992 and 2006, 33 children with tetralogy of Fallot and complete atrioventricular septal defect were admitted; 26 had Down's syndrome (79%). Thirty-two children had complete repair (18 primary, 14 staged); of the 15 who received initial palliation, 1 died before complete repair. Right ventricular outflow tract obstruction was relieved by transannular patch in 14 cases (42%), infundibular patch with preservation of the pulmonary valve in 7 (21%), and right ventricle-to-pulmonary artery conduit in 11 (33%).
  
  
  RESULTS
  There were no hospital deaths. Actuarial survival was 96% +/- 3.9% at 5 years and 85.9 +/- 1.1% at 10 years. Multivariate analysis showed that type of relief of right ventricular outflow tract obstruction did not influence survival (P = .16), nor did the choice to use a valved conduit (P = .82). Primary correction (P = .05) and lower weight at repair (P = .05) were associated with higher probability of survival. Mean follow-up was 69.3 +/- 5.9 months (range 0.2-282 months). There were 2 late deaths. Overall freedom from reoperation was 69% at 5 years and 38% at 10 years. Right ventricular outflow tract reconstruction without use of a valved conduit allowed a significantly higher freedom from reinterventions (P < .05).
  
  
  CONCLUSIONS
  Tetralogy of Fallot associated with complete atrioventricular septal defect can be corrected at low risk with favorable intermediate survival. Use of right ventricle-to-pulmonary artery conduit can be avoided in two thirds of patients with no impact on survival, possibly improving overall freedom from reintervention.
authors.affiliation: Department of Pediatric Cardiothoracic Surgery, Bambino Gesù Pediatric Hospital, Rome, Italy. gbrancaccio70@hotmail.com
authors.forename: Gianluca
authors.initials: G
authors.lastname: Brancaccio
authors.forename: Guido
authors.initials: G
authors.lastname: Michielon
authors.forename: Sergio
authors.initials: S
authors.lastname: Filippelli
authors.forename: Gianluigi
authors.initials: G
authors.lastname: Perri
authors.forename: Duccio
authors.initials: D
authors.lastname: Di Carlo
authors.forename: Fiore S
authors.initials: FS
authors.lastname: Iorio
authors.forename: Gianluca
authors.initials: G
authors.lastname: Oricchio
authors.forename: Roberta
authors.initials: R
authors.lastname: Iacobelli
authors.forename: Antonio
authors.initials: A
authors.lastname: Amodeo
authors.forename: Roberto M
authors.initials: RM
authors.lastname: Di Donato