Early and long-term results of biventricular repair of Tetralogy of Fallot with or without pulmonary atresia

• Published in: Archives of Cardiovascular Diseases Supplements Vol. 10; no. 3-4; p. 280
• Main Authors: Kara, Mansour Mostefa, Villemain, Olivier, Meot, Mathilde, Raisky, Olivier, Bonnet, Damien
• Format: Journal Article
• Language: English
• Published: Elsevier Masson SAS 01.09.2018
• ISSN: 1878-6480
• DOI: 10.1016/j.acvdsp.2018.06.016

After complete repair, the long-term outcome difference between tetralogy of Fallot without pulmonary atresia (TOF) and tetralogy of Fallot with pulmonary atresia (TOF-PA) without MAPCAs is scarcely described. We performed a retrospective study on patients with a diagnostic of TOF and TOF-PA without MAPCAs who underwent complete repair between 1995 and 2016 in our center. We reviewed 960 patients, divided into two main anatomical groups: TOF (n=822, 85.7%), and patients with TOF-PA (n=138, 14.3%). Concerning surgical technique repair, three groups were distinguished: TOF without transannular patch (n=410, 42.7%), TOF/TOF-PA with transannular patch (n=494, 51.5%), and TOF-PA with RVOT tube (n=56, 5.8%). After complete repair, overall mortality was 11 (1.1%), five of them occurred before discharge (0.5%). Survival at 10 years after repair was 99.1% for TOF and 96.8% for TOF-PA (P=0.036). The median follow-up was 10.0 [CI95%: 6.3–14.1] years after repair. One hundred and sixty-three patients underwent reintervention (surgery or percutaneous interventions) (17%). Freedom from reintervention at 10 years after repair was 92.3%, 82.1%, and 48.7% for TOF without transannular patch, TOF/TOF-PA with transannular patch and TOF-PA with RVOT tube respectively (P<0.001 between each groups). In addition, reintervention rate was significantly different between TOF with transannular patch and TOF-PA with pulmonary trunk (P<0.001). In multivariate analysis, the absence of pulmonary trunk (HR 1.7 IC95% [1.1–2.6], P=0.013), pulmonary artery branches stenosis (HR 2.2 IC95% [1.4–3.5], P=0.001), prior palliative surgery (HR 2.6 IC95% [1.8–3.6], P<0.001), and reintervention before discharge (HR 5.4 IC95% [3.8–7.5], P<0.001) were reintervention risk factors. The initial anatomy of pulmonary trunk and branches strongly influences the risk of reintervention in TOF with or without PA. Avoid palliative surgery by directly performing a complete repair in the neonatal period would be a strategical option to improve the prognosis of these patients.