OBJECTIVE: To report the outcomes of patients with tetralogy of Fallot (TOF) undergoing surgical repair at age 40 years or older. PATIENTS AND METHODS: We reviewed records of patients (age, ≥40 years) who underwent TOF repair from January 1, 1970, through December 31, 2007. Symptoms, palliative procedures, surgical reports, and long-term outcomes were analyzed. RESULTS: Fifty-two patients (30 men [58%]) had surgery at a mean ± SD age of 50±8 years; 27 (52%) had prior palliative surgery at a mean ± SD age of 17±11 years. Procedures for TOF repair included pulmonary valve replacement (n=10), transannular patch (n=10), and native pulmonary valve preservation (n=32). The 30-day mortality rate was 6% (stroke, n=2; ventricular fibrillation, n=1). A mean ± SD follow-up of 14.9±9.3 years was feasible in 48 of 49 survivors; improvement in functional class was observed in 42 patients. Reoperation was performed in 7 patients (4 for pulmonary regurgitation). Twenty-nine patients died (mean ± SD age, 65±12 years); causes of death were cardiac (n=7), noncardiac (n=4), and unknown (n=18). Mean ± SD age at death was younger in patients with previous palliation (59±11 years vs 70±12 years; P=.03). The 10-year survival rate was lower than expected compared with an age- and sex-matched population (73% vs 91%; P<.001). CONCLUSION: Complete repair of TOF in patients 40 years or older is feasible but carries increased operative risk. Surgical survivors have improvement in functional class; however, survival remains lower than expected. Reduced survival and need for reoperation emphasize the importance of pulmonary valve replacement at the time of initial repair and long-term follow-up.
OBJECTIVE: To report the outcomes of patients with tetralogy of Fallot (TOF) undergoing surgical repair at age 40 years or older. PATIENTS AND METHODS: We reviewed records of patients (age, ≥40 years) who underwent TOF repair from January 1, 1970, through December 31, 2007. Symptoms, palliative procedures, surgical reports, and long-term outcomes were analyzed. RESULTS: Fifty-two patients (30 men [58%]) had surgery at a mean ± SD age of 50±8 years; 27 (52%) had prior palliative surgery at a mean ± SD age of 17±11 years. Procedures for TOF repair included pulmonary valve replacement (n=10), transannular patch (n=10), and native pulmonary valve preservation (n=32). The 30-day mortality rate was 6% (stroke, n=2; ventricular fibrillation, n=1). A mean ± SD follow-up of 14.9±9.3 years was feasible in 48 of 49 survivors; improvement in functional class was observed in 42 patients. Reoperation was performed in 7 patients (4 for pulmonary regurgitation). Twenty-nine patients died (mean ± SD age, 65±12 years); causes of death were cardiac (n=7), noncardiac (n=4), and unknown (n=18). Mean ± SD age at death was younger in patients with previous palliation (59±11 years vs 70±12 years; P=.03). The 10-year survival rate was lower than expected compared with an age- and sex-matched population (73% vs 91%; P<.001). CONCLUSION: Complete repair of TOF in patients 40 years or older is feasible but carries increased operative risk. Surgical survivors have improvement in functional class; however, survival remains lower than expected. Reduced survival and need for reoperation emphasize the importance of pulmonary valve replacement at the time of initial repair and long-term follow-up.
Authors: E A Bacha; A M Scheule; D Zurakowski; L C Erickson; J Hung; P Lang; J E Mayer; P J del Nido; R A Jonas Journal: J Thorac Cardiovasc Surg Date: 2001-07 Impact factor: 5.209
Authors: G S Van Arsdell; G S Maharaj; J Tom; V K Rao; J G Coles; R M Freedom; W G Williams; B W McCrindle Journal: Circulation Date: 2000-11-07 Impact factor: 29.690
Authors: David M Harrild; Charles I Berul; Frank Cecchin; Tal Geva; Kimberlee Gauvreau; Frank Pigula; Edward P Walsh Journal: Circulation Date: 2009-01-12 Impact factor: 29.690
Authors: Fernando A Atik; Edmar Atik; Claudio R da Cunha; Luiz Fernando Caneo; Renato S Assad; Marcelo B Jatene; Arlindo Riso; Miguel Barbero-Marcial Journal: Eur J Cardiothorac Surg Date: 2004-02 Impact factor: 4.191