Yves d'Udekem1, John C Galati2, Glenda J Rolley3, Igor E Konstantinov4, Robert G Weintraub5, Leeanne Grigg6, James M Ramsay7, Gavin R Wheaton8, Sarah Hope9, Michael H Cheung5, Christian P Brizard4. 1. Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia; Department of Pediatrics of the University of Melbourne, and the Murdoch Children's Institute, Melbourne, Australia. Electronic address: yves.dudekem@rch.org.au. 2. Department of Clinical Epidemiology & Biostatistics Unit, Murdoch Children's Research Institute, Melbourne, Australia; Department of Mathematics and Statistics, La Trobe University, Melbourne, Australia. 3. Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia. 4. Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia; Department of Pediatrics of the University of Melbourne, and the Murdoch Children's Institute, Melbourne, Australia. 5. Department of Cardiology, Royal Children's Hospital, Melbourne, Australia. 6. Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia. 7. Department of Cardiology, Princess Margaret Hospital for Children, Perth, Australia. 8. Department of Cardiology, Women's & Children's Hospital, Adelaide, Australia. 9. Department of Cardiology, Monash Medical Centre, Clayton, Melbourne, Australia.
Abstract
OBJECTIVES: The study sought to evaluate the late outcomes of a policy of transatrial repair delayed beyond the neonatal period. BACKGROUND: Long-term outcomes of transatrial repair of tetralogy of Fallot are unknown. METHODS: The records of 675 consecutive patients undergoing a transatrial repair of tetralogy of Fallot between 1980 and 2005 were reviewed, their follow-up updated and survival confirmed from national death registries. One-third (220 of 675) had undergone previous palliation. Median age at repair was 2 years in the first 8 years, and 1 year from 1988 onward. A transannular incision was performed in 75% of cases and autologous pericardium was the material used to patch this incision in 92% of cases. RESULTS: There were 7 hospital deaths (1%). Eight patients died during follow-up (2 sudden unexpected and 6 noncardiac deaths). Mean follow-up was 11.7 ± 6.3 years. Twenty-five years' survival was 97% (95% confidence interval [CI]: 95% to 98%). Twenty-five years' freedom from implantation of a valved conduit was 84.6% (95% CI: 77.8% to 89.5%). By multivariable analysis, prior palliation and younger age at repair were predictive of implantation of a valved conduit (hazard ratio: 2.4, 95% CI: 1.3 to 4.6, p = 0.008; hazard ratio: 0.70, 95% CI: 0.50 to 0.96, p = 0.03, respectively). CONCLUSIONS: During long-term follow-up, transatrial repair of tetralogy of Fallot was associated with a minimal risk of sudden death and low rate of reintervention for right ventricular dilation and residual outflow tract obstruction.
OBJECTIVES: The study sought to evaluate the late outcomes of a policy of transatrial repair delayed beyond the neonatal period. BACKGROUND: Long-term outcomes of transatrial repair of tetralogy of Fallot are unknown. METHODS: The records of 675 consecutive patients undergoing a transatrial repair of tetralogy of Fallot between 1980 and 2005 were reviewed, their follow-up updated and survival confirmed from national death registries. One-third (220 of 675) had undergone previous palliation. Median age at repair was 2 years in the first 8 years, and 1 year from 1988 onward. A transannular incision was performed in 75% of cases and autologous pericardium was the material used to patch this incision in 92% of cases. RESULTS: There were 7 hospital deaths (1%). Eight patients died during follow-up (2 sudden unexpected and 6 noncardiac deaths). Mean follow-up was 11.7 ± 6.3 years. Twenty-five years' survival was 97% (95% confidence interval [CI]: 95% to 98%). Twenty-five years' freedom from implantation of a valved conduit was 84.6% (95% CI: 77.8% to 89.5%). By multivariable analysis, prior palliation and younger age at repair were predictive of implantation of a valved conduit (hazard ratio: 2.4, 95% CI: 1.3 to 4.6, p = 0.008; hazard ratio: 0.70, 95% CI: 0.50 to 0.96, p = 0.03, respectively). CONCLUSIONS: During long-term follow-up, transatrial repair of tetralogy of Fallot was associated with a minimal risk of sudden death and low rate of reintervention for right ventricular dilation and residual outflow tract obstruction.
Authors: Jouke P Bokma; Koen C de Wilde; Hubert W Vliegen; Arie P van Dijk; Joost P van Melle; Folkert J Meijboom; Aeilko H Zwinderman; Maarten Groenink; Barbara J M Mulder; Berto J Bouma Journal: JAMA Cardiol Date: 2017-06-01 Impact factor: 14.676
Authors: Eva van den Bosch; Ad J J C Bogers; Jolien W Roos-Hesselink; Arie P J van Dijk; Marie H E J van Wijngaarden; Eric Boersma; Aagje Nijveld; Linda W G Luijten; Ronald Tanke; Laurens P Koopman; Willem A Helbing Journal: Eur J Cardiothorac Surg Date: 2020-04-01 Impact factor: 4.191