Determinants of short- and long-term outcome in the surgical correction of tetralogy of Fallot.

Although biventricular correction of tetralogy of Fallot has been with us for well over three decades, the optimal treatment of these patients continues to be debated, and surgical techniques refined. There can be no doubt that operative mortality has improved, and no matter which approach is chosen, an early mortality of less than 5% should be easily achievable. As with most other areas of pediatric cardiology and cardiac surgery, these admirable early results are truly only the beginning. While reflecting the results of surgery in an earlier era, some of the long-term follow-up data beginning to emerge from studies of these patients, particularly in regard to the effect of pulmonary incompetence, is compelling and must be taken into account when deciding the optimal surgical treatment for the individual child presenting today with tetralogy of Fallot. This article reviews some of the more recent data regarding the functional outcome of these patients as well as the surgical approaches that have been developed to address them.