BACKGROUND: Tetralogy of Fallot presenting in adulthood is a surgical challenge. We present the long-term outcomes of surgical correction in this subset of patients, including results of postoperative effort tolerance as assessed by treadmill testing. METHODS: Fifty-eight patients older than 18 years operated on between January 1995 and June 2004 are included in the study. Mean age at surgery was 22.5 +/- 5 years. Forty-seven patients were in New York Heart Association functional class II and 11 were in class III. Two patients had previous shunts. Forty-four patients received a transannular patch, and 14 had a right ventricular outflow tract patch. The prospective arm objectively assessed postoperative ventricular function by treadmill testing and echocardiography. RESULTS: Hospital mortality was 6.9%. Follow-up was 89% complete, with mean follow-up of 69.9 +/- 43 months. Late mortality occurred in 2 patients, both with infective endocarditis. Significant improvement in functional class was demonstrated (p < 0.001). Eight patients had significant pulmonary regurgitation on follow-up. The probability of survival after repair was 89% at 15 years. Thirty-five of 36 patients who underwent treadmill testing had good effort tolerance, with an average of 10.47 +/- 1.4 metabolic equivalents achieved. None had a positive result. One patient with transannular patch, in functional class III, had fair exercise tolerance with severe pulmonary regurgitation on echocardiography. CONCLUSIONS: Repair of adult tetralogy of Fallot has acceptable morbidity and mortality rates with good long-term surgical outcome in terms of effort tolerance as demonstrated by treadmill testing. Transannular patching does not appear to be a significant risk factor for right ventricular failure at long-term follow-up.
BACKGROUND: Tetralogy of Fallot presenting in adulthood is a surgical challenge. We present the long-term outcomes of surgical correction in this subset of patients, including results of postoperative effort tolerance as assessed by treadmill testing. METHODS: Fifty-eight patients older than 18 years operated on between January 1995 and June 2004 are included in the study. Mean age at surgery was 22.5 +/- 5 years. Forty-seven patients were in New York Heart Association functional class II and 11 were in class III. Two patients had previous shunts. Forty-four patients received a transannular patch, and 14 had a right ventricular outflow tract patch. The prospective arm objectively assessed postoperative ventricular function by treadmill testing and echocardiography. RESULTS: Hospital mortality was 6.9%. Follow-up was 89% complete, with mean follow-up of 69.9 +/- 43 months. Late mortality occurred in 2 patients, both with infective endocarditis. Significant improvement in functional class was demonstrated (p < 0.001). Eight patients had significant pulmonary regurgitation on follow-up. The probability of survival after repair was 89% at 15 years. Thirty-five of 36 patients who underwent treadmill testing had good effort tolerance, with an average of 10.47 +/- 1.4 metabolic equivalents achieved. None had a positive result. One patient with transannular patch, in functional class III, had fair exercise tolerance with severe pulmonary regurgitation on echocardiography. CONCLUSIONS: Repair of adult tetralogy of Fallot has acceptable morbidity and mortality rates with good long-term surgical outcome in terms of effort tolerance as demonstrated by treadmill testing. Transannular patching does not appear to be a significant risk factor for right ventricular failure at long-term follow-up.