Ann Thorac Surg 1996;61:1774
© 1996 The Society of Thoracic Surgeons
Invited Commentary
Invited Commentary
C. Walton Lillehei, MD, PhD
73 Otis Lane, St. Paul, MN 55104
See also page 1769.
I appreciate this opportunity to review these remarkable results in the total correction of tetralogy of Fallot in 228 unselected, consecutive patients over an 8-year period. The hospital mortality was less than 1%, and the late mortality, in the 100% follow-up from 6 months to 8 years, was less than 2%. The operations were carried out at the Fu Wai Hospital in Beijing, and the results may be the best ever reported for a similar series undergoing total correction.
I spent 3 days at Fu Wai Hospital in November 1991 as a Visiting Professor, and I can add further testimony to the excellence of cardiovascular treatment in China's best-known teaching hospital.
The author, Dr Qingyu Wu, concludes from his experience that the high-risk factors often cited by others such as hypoplastic pulmonary artery, diminutive left ventricle, old age, and high hematocrit need not contraindicate total corrections. From the earliest days, I have expressed similar judgments. In fact, I have long regarded old age (in tetralogy meaning 20 to 40 years) and severe polycythemia as actually favorable risk factors. The pathology was generally less severe in older patients, and the severe polycythemia made it possible to perform corrections with little or no foreign blood.
Doctor Wu quite correctly concludes that the ``key factor was to correct the pathology completely.'' To accomplish that, he made frequent use of the outflow patch whenever indicated. This valuable concept has stood the test of time, since my colleagues and I introduced it clinically in 1956.
Related Article
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Indication and Technique of Total Correction of Tetralogy of Fallot in 228 Patients
- Qingyu Wu
Ann. Thorac. Surg. 1996 61: 1769-1774.
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