SURGERY FOR TETRALOGY OF FALLOT AT LESS-THAN 6 MONTHS OF AGE - IS PALLIATION OLD-FASHIONED

There is still no consensus regarding the most appropriate protocol fo r managing symptomatic patients with tetralogy of Fallot (TOF) present ing during early infancy. From January 1987 to April 1994, 83 patients with TOF were operated on at less than 6 months of age. Sixty patient s (mean age 109+/-5 days) underwent primary repair and 23 (mean age 72 +/-10 days) underwent initial palliation with a modified Blalock-Tauss ig shunt (MBTS) in 22 cases. No strict protocol was used but patients who received initial palliation had lower weight, smaller pulmonary an nulus or had an anomalous coronary artery. Nineteen of the patients in itially palliated underwent repair at a median of 13 months after pall iation. During this interval, the pulmonary annulus size increased fro m a Z-value of -3.0+/-0.4 at palliation to -1.6+/-0.7 at repair (P=0.0 6) and the summed diameters of pulmonary artery branches from -2.2+/-0 .4 to -1.6+/-0.7 (P=0.2). There were no operative deaths among the rep aired patients, but two patients died early after shunt insertion, Tra nsannular patch was required in 58% of the patients regardless of the management protocol, Actuarial survival rate and freedom from reoperat ion at 48 months were 98.0% and 77.4% (P=0.003) and 87.6% and 90.0% in primarily repaired and initially palliated patients, respectively, Pr imary repair of TOF at the time of presentation is the preferred appro ach regardless of age. Initial MBTS, performed in more unfavorable cas es, did not allow for a disproportionate pulmonary artery growth or re duction of transannular patching and may be reserved for TOF with asso ciated anomalies. Continuing follow-up is needed to confirm these data .