What is the optimal age for repair of tetralogy of Fallot?

Background-Controversy regarding the timing for the repair of tetralogy of Fallot centers around initial palliation versus primary repair for the symp tomatic nconate/young infant and the optimal age for repair of the asymptom atic child. We changed our approach from one of initial palliation in the i nfant to one of primary repair around the age of 6 months, or earlier if cl inically indicated. We examined the effects of this change in protocol and age on outcomes. Methods and Results-The records of 227 consecutive children who had repair of isolated tetralogy of Fallot from January 1993 to June 1998 were reviewe d, The median age of repair by year fell from 17 to 8 months (P<0.01), The presence of a palliative shunt at the time of repair decreased from 38% to 0% (P<0.01), Mortality (6 deaths, 2.5%) improved with time (P=0.02), with n o mortality since the change in protocol (late 1995/early 1996). Multivaria te analysis for physiological outcomes of time to lactate clearance, ventil ation hours, and length of stay, but not death, demonstrated that an age <3 months was independently associated with prolongation of times (P<0.03). E ach of the deaths occurred with primary repair at an age >12 months. The be st survival and physiological outcomes were achieved with primary repair in children aged 3 to 11 months. Conclusions-On the basis of mortality and physiological outcomes, the optim al age for elective repair of tetralogy of Fallot is 3 to ii months of age.