Korean circulation journal · 2026
Long-term Outcomes of Primary Neonatal Tetralogy of Fallot Repair and Risk Factor Analysis of Right Ventricular Outflow Tract and Pulmonary Artery Reintervention.
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Lim Jae Hong, Lee Chang-Ha, Cho Sang Hun, Kim Eung Re, Kim Yong Jin
Аннотация
BACKGROUND AND OBJECTIVES: Neonates with symptomatic tetralogy of Fallot (TOF) often require surgery within the first month of life, but the optimal strategy remains uncertain. This study assessed outcomes and risk factors for right ventricular outflow tract (RVOT) and pulmonary artery (PA) reintervention after neonatal primary repair.
METHODS: Between 2004 and 2021, 42 neonates underwent primary TOF repair and were retrospectively analyzed. Mean follow-up was 12.2±5.7 years. Twenty-seven patients (64.3%) had TOF with pulmonary atresia, and 15 (35.7%) had TOF with pulmonary stenosis.
RESULTS: Overall survival at 15 years was 92.9%, with one hospital and two late deaths. Reintervention for RVOT and/or PA lesions was required in 35 patients (83.3%). Surgical reintervention occurred in 26 patients (61.9%), catheter-based reintervention in 29 (69.0%), and both in 20 (47.6%). Freedom from reintervention at 10 years was only 14.3%. Median time to first reintervention was 7.3 months (interquartile range, 4.3-17.8). On multivariable analysis, pulmonary atresia and smaller left pulmonary artery (LPA) size predicted reintervention. Specifically, the pulmonary atresia group had a higher reintervention burden than the pulmonary stenosis group (p=0.005), and each unit increase in LPA z-score reduced the risk of reintervention (p=0.022). An LPA z-score <-2.27 was associated with an increased risk of reintervention.
CONCLUSIONS: Neonatal TOF repair provides excellent long-term survival but is associated with frequent RVOT and PA reinterventions. Careful preoperative evaluation, particularly of LPA dimensions, may help identify patients at higher risk for reintervention and optimize postoperative management.
METHODS: Between 2004 and 2021, 42 neonates underwent primary TOF repair and were retrospectively analyzed. Mean follow-up was 12.2±5.7 years. Twenty-seven patients (64.3%) had TOF with pulmonary atresia, and 15 (35.7%) had TOF with pulmonary stenosis.
RESULTS: Overall survival at 15 years was 92.9%, with one hospital and two late deaths. Reintervention for RVOT and/or PA lesions was required in 35 patients (83.3%). Surgical reintervention occurred in 26 patients (61.9%), catheter-based reintervention in 29 (69.0%), and both in 20 (47.6%). Freedom from reintervention at 10 years was only 14.3%. Median time to first reintervention was 7.3 months (interquartile range, 4.3-17.8). On multivariable analysis, pulmonary atresia and smaller left pulmonary artery (LPA) size predicted reintervention. Specifically, the pulmonary atresia group had a higher reintervention burden than the pulmonary stenosis group (p=0.005), and each unit increase in LPA z-score reduced the risk of reintervention (p=0.022). An LPA z-score <-2.27 was associated with an increased risk of reintervention.
CONCLUSIONS: Neonatal TOF repair provides excellent long-term survival but is associated with frequent RVOT and PA reinterventions. Careful preoperative evaluation, particularly of LPA dimensions, may help identify patients at higher risk for reintervention and optimize postoperative management.