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The Annals of Thoracic Surgery, Vol 54, 903-907, Copyright © 1992 by The Society of Thoracic Surgeons
TR Karl, S Sano, S Pornviliwan and RB Mee
This report describes our experience with 366 patients who had a
transatrial, transpulmonary repair of tetralogy of Fallot between December
1980 and December 1991. Included in this group are patients with tetralogy
of Fallot plus atrioventricular septal defect as well as patients
displaying all degrees of aortic override (in the presence of subaortic
ventricular septal defect and right ventricular outflow tract obstruction).
Median age was 15.3 months and median weight, 12.3 kg. Of the 366 patients,
72% required a pericardial patch to reconstruct the main pulmonary artery
or right ventricular outflow tract. Serious coronary anomalies were seen in
11 patients, without influencing surgical approach. There were two hospital
deaths (0.5%; 70% confidence limits, 0.2% to 1.2%). Actuarial survival was
97.5% at 42 months (95% confidence limits, 95% to 99%) reflecting four late
deaths over 1,129 patient-years of follow-up. Postoperative cardiac
catheterization studies were performed in 61 patients at a mean follow-up
interval of 23 months. Mean right ventricular/left ventricular systolic
pressure ratio after repair was 0.46 (standard deviation, 0.28), and mean
gradient across the right ventricular outflow tract was 15 mm Hg (standard
deviation, 24 mm Hg). Actuarial freedom from reoperation for any reason has
been 95% (95% confidence limits, 92% to 97%) at 5-year and 10-year
follow-up. These early and medium-term results encourage us to continue
with transatrial, transpulmonary repair of tetralogy of Fallot. We believe
that this approach has an operative risk similar to or lower than
transventricular repair, and that it will result in better preservation of
right ventricular function in the long term.
ARTICLES
Tetralogy of Fallot: favorable outcome of nonneonatal transatrial, transpulmonary repair
Victorian Paediatric Cardiac Surgical Unit, Royal Children's Hospital, Australia.
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