Repair of tetralogy of Fallot in or beyond the fourth decade of life.
OBJECTIVE
Patients with tetralogy of Fallot (TOF) undergoing surgery in adulthood represent a challenge. We report our experience with such patients in or beyond the fourth decade of life.


METHODS
Retrospective cohort.


METHODS
Multispeciality tertiary level referral center


METHODS
Forty-one (age 30-52 years) with TOF undergoing surgery between January 2002 and March 2013. The hospital records of these patients were analyzed.


METHODS
None.


METHODS
Early and late morbidity and mortality, duration of mechanical ventilatory support, inotropic score, intensive care unit and hospital stay, and correlation with various parameters.


RESULTS
Significant aortopulmonary collaterals were present in 28 patients; these were occluded in cardiac catheterization laboratory prior to repair. Median intraoperative right:left ventricular pressure ratio was 0.40 (range 0.2-0.8). Median inotropic score was 10 (range 5-30). Median duration of mechanical ventilation was 12 hours (range 6-48 hours). Preoperative oxygen saturation was negatively correlated with inotropic score (P = .001, r = -0.485), mechanical ventilatory support (P = .003, r = -0.460), intensive care unit stay (P = .004, r = -0.442), and hospital stay (P = .028, r = -353). Inotropic score was higher in patients with aortopulmonary collaterals (n = 28, P = .03), high preoperative hematocrit (n = 29, P = .029), and with right ventricular dysfunction (n = 6, P = .05). Patients with right ventricular outflow tract gradient >80 mm Hg (n = 19) had prolonged hospital stay (P = .002). Patients undergoing pure transatrial repair (n = 24) showed lower inotropic score (P = .045), less intensive care unit (P = .04), and hospital stay (P = .031). There were two early and two late deaths (one from trauma and one from unknown etiology). Median follow-up was 42 months. Thirty-one patients were in New York Heart Association class II and six were in class III.


CONCLUSIONS
Repair of TOF in and beyond the fourth decade of life is feasible with acceptable results. Patients with high hematocrit, lower oxygen saturation, right ventricular dysfunction, aortopulmonary collaterals, and high preoperative right ventricular outflow tract gradients have a prolonged postoperative course.
Cardiothoracic Center, All India Institute of Medical Sciences, New Delhi, India.
Sachin
S
Talwar
Ajay
A
Meena
Shiv Kumar
SK
Choudhary
Anita
A
Saxena
Shyam Sunder
SS
Kothari
Rajnish
R
Juneja
Balram
B
Airan
D000328:Adult; D000367:Age Factors; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D003097:Collateral Circulation; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007194:India; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000503:physiopathology / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors; D062606:Tertiary Care Centers; D013771:Tetralogy of Fallot / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D018497:Ventricular Dysfunction, Right / Q000209:etiology / Q000503:physiopathology; D016277:Ventricular Function, Left; D016278:Ventricular Function, Right; D014694:Ventricular Outflow Obstruction / Q000209:etiology / Q000503:physiopathology
Adult Congenital Heart Disease; Congenital Cyanotic Heart Disease; Tetralogy of Fallot