Twenty-to-thirty-seven-year follow-up after repair for Tetralogy of Fallot

Objective: To describe the long-term prognosis after repair of Tetralogy of Fallot with pulmonary stenosis beyond 20 years. Methods: One hundred and e ighty five patients underwent corrective repair of Tetralogy of Fallot at R igshospitalet in Copenhagen between January 1960 and July 1977. Ninety seve n patients had undergone a palliative operation prior to Tetralogy of Fallo t repair. All the 125 patients who were discharged from the hospital were t raced through the population register and the patients alive July 1997 were contacted by mail and/or telephone and questioned about use of medicine, p rofessional status, family status and ability to perform sport activities. Results: Sixty patients died in hospital and 125 patients, 78 males and 47 females, were discharged alive. Among operative survivors, median age at op eration was 12.8 years (range 0.4-41 years). Thirteen patients required a r eoperation, the main indication was failed VSD closure. There were 16 late cardiac deaths, out of which seven were sudden and unexpected and three wer e in immediate relation to reoperations. One hundred and nine patients were alive at follow-up. The mean follow-up time was 25.5 years (range 20-38 ye ars). Sixteen percent used cardiac drugs, 89% were, or had been, working no rmally (all professions from academics to hard manual labors were represent ed), 53% (64% of women) had given birth after the repair and 51% performed sport activities regularly. No patients were lost to follow-up. Conclusions : The vast majority of the patients seemed to live normal lives 20-37 years after Tetralogy of Fallot repair. Late deaths were cardiac in origin, incl uding sudden death from arrhythmias. The number of late reoperation has bee n low. Considering the natural history of the disease, Fallot repair has pr oven to be a beneficial procedure even including the very early experience short after introduction of open heart surgery. (C) 1999 Elsevier Science B .V. All rights reserved.