- 作者：Yves d'Udekem ; John C. Galati ; Glenda J. Rolley ; Igor E. Konstantinov ; Robert G. Weintraub ; Leeanne Grigg ; James M. Ramsay ; Gavin R. Wheaton ; Sarah Hope ; Michael H. Cheung ; Christian P. Brizard
- 关键词：cardiac surgery ; congenital heart disease ; long-term outcome ; pulmonary valve ; tetralogy of Fallot
- 刊名：Journal of the American College of Cardiology
- 出版年：18 February, 2014
- 年：2014
- 卷：63
- 期：6
- 页码：563-568
- 全文大小：683 K
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 卤 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聽= 0.008; hazard ratio: 0.70, 95% CI: 0.50 to 0.96, p聽= 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.