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Ann Thorac Surg 1989;48:783-791
© 1989 The Society of Thoracic Surgeons

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Articles

Effect of transannular patching on outcome after repair of tetralogy of Fallot

Division of Cardiothoracic Surgery, Department of Surgery, The University of Alabama at Birmingham School of Medicine and Medical Center, Birmingham, Alabama, USA

Accepted for publication August 15, 1989.

^_* Address reprint requests to Dr John W. Kirklin, Department of Surgery, The University of Alabama at Birmingham, UAB Station, Birmingham, AL 35294.

Among 814 patients undergoing repair of tetralogy of Fallot with pulmonary stenosis between 1967 and May 1986, transannular patching in the current era was a weak risk factor for death early postoperatively (predicted 30-day mortality, 4% with a transannular patch and 1.4% without) and is not a risk factor for instantaneous risk of death late postoperatively (predicted 20-year survival including early death, 94% with a transannular patch and 96.5% without). Ninety-six percent of surviving patients were in New York Heart Association functional class I at last follow-up, and the slight decline in this percentage as the interval between operation and last follow-up lengthened could have been due to chance alone (p = 0.24) and was no different in patients with a transannular patch. Transannular patching was a risk factor for reoperation for pulmonary regurgitation late postoperatively, but only a 7% incidence within 20 years is predicted when mild residual stenoses are beyond the patch: the incidence rises to about 20% with important distal stenoses. Inferences from the study are relevant to the indications for transannular patching and insertion of allograft semilunar valves at the time of repair.

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