title: Single-center 50 years' experience with surgical management of tetralogy of Fallot.
abstract: OBJECTIVE
  The aim of this study was to evaluate the long-term outcome of total repair for tetralogy of Fallot. We aimed to characterize late survival and the time-related risk of late reoperation.
  
  
  METHODS
  Operative protocols, patient records, and the database of the department were evaluated from 1951 until 2008. The official death registry of Norway was used for follow-up. Of the patients identified, the follow-up was 99.6% complete.
  
  
  RESULTS
  A total of 627 patients were studied. Of these, 570 could be identified for follow-up. There were a total of 41 early and 30 late deaths. The total early (including palliative procedures) mortality was 7.2% and total late mortality was 7.9%. However, during the last 10 years, no early mortality has been observed following repair. A total of 264 patients underwent some form of palliative procedure as their first treatment, and 541 patients had a reparative procedure performed, with an early mortality of 31 (5.7%). In patients subjected to a reparative procedure, there was no difference in freedom from death or reoperation following primary repair versus primary palliation. The use of transannular patch was associated with a highly significant risk of reoperation.
  
  
  CONCLUSIONS
  Surgical treatment of the tetralogy of Fallot and related congenital cardiac malformations has good long-term prognosis. In this cohort of patients, more than one-third required additional procedures later on, and, in some cases, as many as four additional surgeries. Palliative procedures followed by repair do not influence survival or reoperation-free survival. There are no differences between transatrial versus transventricular repair on survival or re-repair. Any transannular incision increases the risk of re-repair, but does not influence long-time survival. There is an almost linear decrease in reoperation-free survival following any type of repair of tetralogy of Fallot, even for as long as 50 years since the first procedure.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Section of Congenital Cardiac Surgery, Oslo University Hospital, Oslo, Norway.
authors.forename: Harald L
authors.initials: HL
authors.lastname: Lindberg
authors.forename: Kjell
authors.initials: K
authors.lastname: Saatvedt
authors.forename: Egil
authors.initials: E
authors.lastname: Seem
authors.forename: Tom
authors.initials: T
authors.lastname: Hoel
authors.forename: Sigurd
authors.initials: S
authors.lastname: Birkeland
mesh_terms: D000367:Age Factors; D002675:Child, Preschool; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000601:surgery; D006801:Humans; D007223:Infant; D009664:Norway / Q000453:epidemiology; D010166:Palliative Care / Q000379:methods; D011379:Prognosis; D019736:Prostheses and Implants; D012086:Reoperation / Q000706:statistics & numerical data; D016019:Survival Analysis; D013771:Tetralogy of Fallot / Q000401:mortality / Q000601:surgery*; D016896:Treatment Outcome