title: Right ventricular outflow tract reconstruction with an allograft conduit in patients after tetralogy of Fallot correction: long-term follow-up.
abstract: BACKGROUND
  In tetralogy of Fallot (TOF) pulmonary regurgitation is a frequent complication after initial repair. The objective of the present study was to describe the long-term experience with the use of allograft conduits for right ventricular outflow tract (RVOT) reconstruction after correction of TOF in our institution.
  
  
  METHODS
  Between 1987 and 2009, 133 allografts were implanted in 126 patients (mean age, 27.8 years). The mean time from initial TOF repair to allograft implantation was 20.8±8.8 years. Kaplan-Meier analyses were done for patient survival, freedom from allograft replacement and freedom from any cardiovascular event.
  
  
  RESULTS
  Hospital mortality was 1.5% (2 patients). Mean follow-up was 8.1 years. Ten other patients died during late follow-up, in 8 patients the cause was heart failure. Patient survival was 95% at 5 years, 91% at 10 years, and 80% at 15 years. Male sex, older patient age at the time of operation, and the use of preoperative diuretics were associated with increased risk of mortality during follow-up. Freedom from allograft replacement was 83% at 10 years and 70% at 15 years. Freedom from any valve-related event was 80% at 10 years and 67% at 15 years.
  
  
  CONCLUSIONS
  Right ventricular outflow tract reconstruction after previous TOF repair can be performed with low risk and a low reintervention rate. Allograft conduits function satisfactorily in the pulmonary position at longer-term follow-up. Functional status after allograft implantation in patients with a previous correction of TOF remains good. There is concern about the long-term survival and the occurrence of heart failure.
authors: Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands. p.vandewoestijne@erasmusmc.nl
authors: Pieter C
authors: PC
authors: van de Woestijne
authors: M Mostafa
authors: MM
authors: Mokhles
authors: Peter L
authors: PL
authors: de Jong
authors: Maarten
authors: M
authors: Witsenburg
authors: Johanna J M
authors: JJ
authors: Takkenberg
authors: Ad J J C
authors: AJ
authors: Bogers