Reoperation in adults with repair of tetralogy of Fallot: Indications and outcomes

Objective: The purpose of this study is to review indications, surgical pro cedures, and outcomes in adults with repaired tetralogy of Fallot referred for reoperation. Method: Sixty consecutive adults (age greater than or equa l to 18 years) who underwent reoperation between 1975 and 1997 after previo us repair of tetralogy of Fallot were reviewed. Mean age at corrective repa ir was 13.3 +/- 9.6 years and at reoperation 33.3 +/- 9.6 years. Mean follo w-up after reoperation is 5.0 +/- 4.9 years. Results: Long-term complicatio ns of the right ventricular outflow tract (n = 45, 75%) were the most commo n indications for reoperation: severe pulmonary regurgitation (n = 23, 38%) and conduit failure (n = 13, 22%) were most frequent. Less common indicati ons were ventricular septal patch leak (n = 6) and severe tricuspid regurgi tation (n = 3). A history of sustained ventricular tachycardia was present in 20 patients (33%) and supraventricular tachycardia occurred in 9 patient s (15%). A bioprosthetic valve to reconstruct the right ventricular outflow tract was used in 42 patients, Additional procedures (n = 115) to correct other residual lesions were required in 46 patients (77%). There was no per ioperative mortality. Actuarial 10-year survival is 92% +/- 6%. At most rec ent follow-up, 93% of the patients are in New York Heart Association classi fication I or II. Sustained ventricular tachycardia occurred in 4 patients (7%) during follow-up. Conclusions: Long-term complications of the right ve ntricular outflow tract were the main reason for reoperation. Mid-term surv ival and functional improvement after reoperation are excellent.