title: Neither age at repair nor previous palliation affects outcome in tetralogy of Fallot repair.
abstract: OBJECTIVE
  The study aimed to evaluate the results following complete repair of tetralogy of Fallot (TOF) in relation to age at surgery and to assess the role of palliation in the current era.
  
  
  METHODS
  A retrospective review of 251 consecutive patients with TOF repaired between 2003 and 2011 at the Great Ormond Street Hospital was performed. Children were divided into two groups: Group A, younger than 6 months (n = 78) and B, older than 6 months (n = 173). Early clinical outcomes and reoperation/reintervention rates were studied as well as indication for a palliation.
  
  
  RESULTS
  There was 1 (0.4%) early and 1 (0.4%) late death after a median follow-up time of 4.5 years. Forty-three patients (17%) underwent repair after initial palliation with inter-stage mortality of 5%. Groups A and B were similar in terms of surgical approach, postoperative complications and length of stay. Significant differences were found in terms of more frequent use of a transannular patch (P = 0.05), longer surgeries (P = 0.02) and a greater proportion of palliated patients (P = 0.002) in older patients. There was no difference in rates of reoperation/reintervention between groups and following both primary and staged repair. Palliated patients were more symptomatic (duct-dependent pulmonary blood flow; P < 0.01, cyanotic spells; P < 0.01), had more extracardiac/genetic anomalies (P < 0.01), coronary anomalies (P = 0.015) and significantly smaller pulmonary annulus, right pulmonary artery (RPA) and left pulmonary artery (LPA) Z-scores (P < 0.01 for all).
  
  
  CONCLUSIONS
  Age at complete repair was not linked to early clinical outcome or reoperation/reintervention rate. Palliative procedures postponed the timing of complete repair, but did not increase the reintervention rate.
authors.affiliation: Cardiothoracic Surgery Department, Great Ormond Street Hospital, London, UK.
authors.forename: Branko
authors.initials: B
authors.lastname: Mimic
authors.forename: Kate L
authors.initials: KL
authors.lastname: Brown
authors.forename: Nilesh
authors.initials: N
authors.lastname: Oswal
authors.forename: Jacob
authors.initials: J
authors.lastname: Simmonds
authors.forename: Tain-Yen
authors.initials: TY
authors.lastname: Hsia
authors.forename: Victor T
authors.initials: VT
authors.lastname: Tsang
authors.forename: Marc R
authors.initials: MR
authors.lastname: De Leval
authors.forename: Martin
authors.initials: M
authors.lastname: Kostolny
mesh_terms: D000367:Age Factors; D006348:Cardiac Surgical Procedures / Q000401:mortality*; D005260:Female; D006801:Humans; D007223:Infant; D053208:Kaplan-Meier Estimate; D008297:Male; D010166:Palliative Care; D012086:Reoperation / Q000401:mortality; D013771:Tetralogy of Fallot / Q000453:epidemiology* / Q000601:surgery*
keywords: Palliation; Primary repair; Tetralogy of Fallot