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Influence of early repair of tetralogy of Fallot without an outflow patch on late arrhythmias and sudden death: a 27-year follow-up study following a uniform surgical approach

Published online by Cambridge University Press:  30 July 2009

Hiromichi Hamada ,
Masaru Terai ,
Toshiaki Jibiki ,
Tsunetaro Nakamura ,
Michael A. Gatzoulis  and
Koichiro Niwa
Hiromichi Hamada*
Affiliation:
Department of Pediatrics and Cardiovascular surgery, Chiba Cardiovascular Center; Department of Pediatrics, Graduate School of Medicine, Chiba University, Chiba, Japan; and Adult Congenital Programme, Royal Brompton Hospital, London, UK
Masaru Terai
Affiliation:
Department of Pediatrics and Cardiovascular surgery, Chiba Cardiovascular Center; Department of Pediatrics, Graduate School of Medicine, Chiba University, Chiba, Japan; and Adult Congenital Programme, Royal Brompton Hospital, London, UK
Toshiaki Jibiki
Affiliation:
Department of Pediatrics and Cardiovascular surgery, Chiba Cardiovascular Center; Department of Pediatrics, Graduate School of Medicine, Chiba University, Chiba, Japan; and Adult Congenital Programme, Royal Brompton Hospital, London, UK
Tsunetaro Nakamura
Affiliation:
Department of Pediatrics and Cardiovascular surgery, Chiba Cardiovascular Center; Department of Pediatrics, Graduate School of Medicine, Chiba University, Chiba, Japan; and Adult Congenital Programme, Royal Brompton Hospital, London, UK
Michael A. Gatzoulis
Affiliation:
Department of Pediatrics and Cardiovascular surgery, Chiba Cardiovascular Center; Department of Pediatrics, Graduate School of Medicine, Chiba University, Chiba, Japan; and Adult Congenital Programme, Royal Brompton Hospital, London, UK
Koichiro Niwa
Affiliation:
Department of Pediatrics and Cardiovascular surgery, Chiba Cardiovascular Center; Department of Pediatrics, Graduate School of Medicine, Chiba University, Chiba, Japan; and Adult Congenital Programme, Royal Brompton Hospital, London, UK
*
Department of Pediatrics, Graduate school of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8670, Japan. Tel: +81 43 226 2144; Fax: +81 43 226 2145; E-mail: [email protected]
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Abtsract

Pulmonary regurgitation and older age at the time of repair may have a large impact late after repair on subsequent mortality of patients with tetralogy of Fallot. We aimed to identify whether age at repair, and preservation of the pulmonary valve, had a favorable influence on morbidity and mortality. We also analyzed risk factors for late death subsequent to surgical repair. We identified 167 patients who, between 1965 and 1975, and at a mean age of 6 years, underwent total repair of tetralogy of Fallot by a single surgical team without use of an outflow patch. All patients were known to have survived for at least 30 days after repair, and late mortality was identified though the use of hospital records, interviews, and death certificates. The 29-year actuarial survival rate was 86%, with 24 late deaths. Of these deaths, seven occurred suddenly (4.2%). Morbidity was analyzed in 99 of the patients by means of a written questionnaire and telephone interview. It proved possible to analyze ventricular and valvar function in 50 of the patients. Survivors experienced no re-intervention, and 89% of them were in class I of the grading system of the New York Heart Association. We found evidence of 3 episodes of sustained ventricular tachycardia (3.0%), and two episodes of atrial tachycardia (2.0%). Of the 50 patients in whom serial examinations were available, 18 had pulmonary regurgitation of moderate degree or greater, and none had more than moderate tricuspid regurgitation, with a mean QRS duration of 148ms and an ejection fraction for the left ventricle of 50%. Older age at repair (p = 0.03), and longer periods of cardiac arrest during repair (p = 0.02), were associated with late mortality. Although the mortality was similar to that observed in previous reports, our operative method might have a better effect in terms of late morbidity.

Keywords

Sudden cardiac deathadult congenital heart diseasetransjunctional outflow patch
Type
Original Articles
Information
Cardiology in the Young , Volume 12 , Issue 4 , July 2002 , pp. 345 - 351
Copyright
Copyright © Cambridge University Press 2002

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