Outcome after repair of tetralogy of Fallot in the first year of life

Background. The purpose of this study was to evaluate the early and late ou tcome after repair of tetralogy of Fallot in the first year of life. Methods. Between 1974 and 2000, 89 consecutive infants with a mean age of 6 .3 +/- 2.6 months (range, 15 days to 12 months) underwent repair of tetralo gy of Fallot (ventricular septal defect and pulmonary stenosis) by one surg eon (J.L.M.). Three infants had previous palliative operations. Sixty-seven procedures were urgent or emergency. A transannular patch was inserted in 69 patients (77.5%). Follow-up was complete, averaging 13.4 +/- 5.6 years ( range, 0 to 25.4 years). Results. There was one operative death (1.1%). Mean right ventricular to le ft ventricular pressure ratio postoperatively was 0.4 +/- 1.1 (in 79 patien ts, < 0.5). Fourteen patients underwent reoperations or reinterventions. Th ere were no reoperations for residual or recurrent ventricular septal defec t. Kaplan-Meier freedom from reoperation or reintervention for any cause at 20 years was 85% +/- 4.4%, for relief of right ventricular outflow tract o bstruction it was 94% +/- 3.1%, and for pulmonary valve replacement this wa s 95.4% +/- 2.6%. Use of a transannular patch did not significantly affect the need for reoperation or reintervention. There was one late death (leuke mia). Kaplan-Meier 20-year survival was 97.8% +/- 1.9%. On latest echocardi ography, 42 patients had moderate pulmonary regurgitation, 4 had a right ve ntricular outflow tract gradient more than 40 mm Hg, and 86 had good bivent ricular function. Twelve-lead electrocardiography was performed in all and 24-hour electrocardiography in 61 patients. One patient (1.1%) exhibited la te recurrent ventricular tachycardia requiring implantation of a defibrilla tor. The remaining 86 patients are in New York Heart Association class I wi th none of them receiving antiarrhythmic medications. Conclusions. These data strongly support the concept of early repair of tet ralogy of Fallot. It is associated with an acceptable operative risk and a low incidence of significant arrhythmias, and provides long-term survival s imilar to that observed in the general population. Late complications may, however, develop, and long-term follow-up for their early recognition is es sential. (C) 2001 by The Society of Thoracic Surgeons.