title: Low risk of pulmonary valve implantation after a policy of transatrial repair of tetralogy of Fallot delayed beyond the neonatal period: the Melbourne experience over 25 years.
abstract: OBJECTIVE
  The study sought to evaluate the late outcomes of a policy of transatrial repair delayed beyond the neonatal period.
  
  
  BACKGROUND
  Long-term outcomes of transatrial repair of tetralogy of Fallot are unknown.
  
  
  METHODS
  The records of 675 consecutive patients undergoing a transatrial repair of tetralogy of Fallot between 1980 and 2005 were reviewed, their follow-up updated and survival confirmed from national death registries. One-third (220 of 675) had undergone previous palliation. Median age at repair was 2 years in the first 8 years, and 1 year from 1988 onward. A transannular incision was performed in 75% of cases and autologous pericardium was the material used to patch this incision in 92% of cases.
  
  
  RESULTS
  There were 7 hospital deaths (1%). Eight patients died during follow-up (2 sudden unexpected and 6 noncardiac deaths). Mean follow-up was 11.7 ± 6.3 years. Twenty-five years' survival was 97% (95% confidence interval [CI]: 95% to 98%). Twenty-five years' freedom from implantation of a valved conduit was 84.6% (95% CI: 77.8% to 89.5%). By multivariable analysis, prior palliation and younger age at repair were predictive of implantation of a valved conduit (hazard ratio: 2.4, 95% CI: 1.3 to 4.6, p = 0.008; hazard ratio: 0.70, 95% CI: 0.50 to 0.96, p = 0.03, respectively).
  
  
  CONCLUSIONS
  During long-term follow-up, transatrial repair of tetralogy of Fallot was associated with a minimal risk of sudden death and low rate of reintervention for right ventricular dilation and residual outflow tract obstruction.
authors: Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia; Department of Pediatrics of the University of Melbourne, and the Murdoch Children's Institute, Melbourne, Australia. Electronic address: yves.dudekem@rch.org.au.
authors: Yves
authors: Y
authors: d'Udekem
authors: Department of Clinical Epidemiology & Biostatistics Unit, Murdoch Children's Research Institute, Melbourne, Australia; Department of Mathematics and Statistics, La Trobe University, Melbourne, Australia.
authors: John C
authors: JC
authors: Galati
authors: Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia.
authors: Glenda J
authors: GJ
authors: Rolley
authors: Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia; Department of Pediatrics of the University of Melbourne, and the Murdoch Children's Institute, Melbourne, Australia.
authors: Igor E
authors: IE
authors: Konstantinov
authors: Department of Cardiology, Royal Children's Hospital, Melbourne, Australia.
authors: Robert G
authors: RG
authors: Weintraub
authors: Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia.
authors: Leeanne
authors: L
authors: Grigg
authors: Department of Cardiology, Princess Margaret Hospital for Children, Perth, Australia.
authors: James M
authors: JM
authors: Ramsay
authors: Department of Cardiology, Women's & Children's Hospital, Adelaide, Australia.
authors: Gavin R
authors: GR
authors: Wheaton
authors: Department of Cardiology, Monash Medical Centre, Clayton, Melbourne, Australia.
authors: Sarah
authors: S
authors: Hope
authors: Department of Cardiology, Royal Children's Hospital, Melbourne, Australia.
authors: Michael H
authors: MH
authors: Cheung
authors: Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia; Department of Pediatrics of the University of Melbourne, and the Murdoch Children's Institute, Melbourne, Australia.
authors: Christian P
authors: CP
authors: Brizard
mesh_terms: D006348:Cardiac Surgical Procedures / Q000706:statistics & numerical data*; D002675:Child, Preschool; D003490:Cyanosis / Q000628:therapy; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D008297:Male; D010166:Palliative Care; D011664:Pulmonary Valve / Q000601:surgery; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013771:Tetralogy of Fallot / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D014739:Victoria / Q000453:epidemiology
keywords: cardiac surgery; congenital heart disease; long-term outcome; pulmonary valve; tetralogy of Fallot