Surgery for tetralogy of Fallot at less than six months of age. Is palliation "old-fashioned"?

There is still no consensus regarding the most appropriate protocol for managing symptomatic patients with tetralogy of Fallot (TOF) presenting during early infancy. From January 1987 to April 1994, 83 patients with TOF were operated on at less than 6 months of age. Sixty patients (mean age 109 +/- 5 days) underwent primary repair and 23 (mean age 72 +/- 10 days) underwent initial palliation with a modified Blalock-Taussig shunt (MBTS) in 22 cases. No strict protocol was used but patients who received initial palliation had lower weight, smaller pulmonary annulus or had an anomalous coronary artery. Nineteen of the patients initially palliated underwent repair at a median of 13 months after palliation. During this interval, the pulmonary annulus size increased from a Z-value of -3.0 +/- 0.4 at palliation to -1.6 +/- 0.7 at repair (P = 0.06) and the summed diameters of pulmonary artery branches from -2.2 +/- 0.4 to -1.6 +/- 0.7 (P = 0.2). There were no operative deaths among the repaired patients, but two patients died early after shunt insertion. Transannular patch was required in 58% of the patients regardless of the management protocol. Actuarial survival rate and freedom from reoperation at 48 months were 98.0% and 77.4% (P = 0.003) and 87.6% and 90.0% in primarily repaired and initially palliated patients, respectively. Primary repair of TOF at the time of presentation is the preferred approach regardless of age.(ABSTRACT TRUNCATED AT 250 WORDS)