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Ann Thorac Surg 2002;73:96-101
© 2002 The Society of Thoracic Surgeons

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Original article: cardiovascular

How to diminish reoperation rates after initial repair of tetralogy of Fallot?

^a Clinics for Cardiovascular Surgery, University Hospital, Geneva, Switzerland
^b Pediatric Cardiology, University Hospital, Geneva, Switzerland

Accepted for publication September 14, 2001.

* Address reprint requests to Dr Christenson, Clinic for Cardiovascular Surgery, University Hospital, rue Micheli-du-Crest 24, CH-1211 Geneva 14, Switzerland
e-mail: jan.christenson{at}hcuge.ch

Background. Complete correction of tetralogy of Fallot has good long-term results. Right ventricular outflow tract obstruction and pulmonary insufficiency occur which require reintervention. The present study evaluated the efficacy of reoperation following complete correction of tetralogy of Fallot, the sites of recurrences and impact of techniques used at first operation.

Methods. Between 1980 and 1999, 501 patients underwent complete correction of tetralogy of Fallot. Reoperation rate was 7.4%. Residual or recurrent right ventricular outflow tract stenosis was seen in 25 patients (68%), and 7 patients (19%) had severe pulmonary insufficiency. Age at redo was 9.1 ± 6.4 years. Restenosis was most frequently observed (75%) at the bifurcation of the pulmonary artery. Extended 1-patch enlargement was used until 1989 and thereafter changed to a 2-patch technique.

Results. Valvar-supravalvar 1-patch technique had a redo rate of 33.3%, compared with 4.3% for the 2-patch technique, p = 0.0264, with excellent freedom from reoperation rate. At reoperation right ventricular-pulmonary artery (RV-PA) conduits managed 29 patients and 3 had supravalvar patch enlargement. Hospital mortality was 5.4% (2 of 37). Twenty-five patients (68%) were in New York Heart Association functional class I to II at end of the follow-up, and none required further interventions.

Conclusions. Redo rate following complete correction of tetralogy of Fallot was 7.4%. Right ventricular outflow tract pathology was the dominant reason for reoperations (86%). At reoperation, RV-PA conduits was the most frequently used technique. Reoperation was efficient in reducing the RV-PA gradient, had low hospital and late mortality. A 2-patch valvar-supravalvar enlargement at first operation reduced the risk for redo in long-term follow-up.

This article has been cited by other articles:

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				A. F. Corno Can any conclusion be justified with a 27% loss of patients at follow-up? Ann. Thorac. Surg., January 1, 2003; 75(1): 322 - 322. [Full Text] [PDF]

				J. T. Christenson and A. Kalangos Can any conclusion be justified with a 27% loss of patients at follow-up? Reply Ann. Thorac. Surg., January 1, 2003; 75(1): 322 - 322. [Full Text] [PDF]