How to diminish reoperation rates after initial repair of tetralogy of Fallot?

BACKGROUND

Complete correction of tetralogy of Fallot has good long-term results. Right ventricular outflow tract obstruction and pulmonary insufficiency occur which require reintervention. The present study evaluated the efficacy of reoperation following complete correction of tetralogy of Fallot, the sites of recurrences and impact of techniques used at first operation.

METHODS

Between 1980 and 1999, 501 patients underwent complete correction of tetralogy of Fallot. Reoperation rate was 7.4%. Residual or recurrent right ventricular outflow tract stenosis was seen in 25 patients (68%), and 7 patients (19%) had severe pulmonary insufficiency. Age at redo was 9.1+/-6.4 years. Restenosis was most frequently observed (75%) at the bifurcation of the pulmonary artery. Extended 1-patch enlargement was used until 1989 and thereafter changed to a 2-patch technique.

RESULTS

Valvar-supravalvar 1-patch technique had a redo rate of 33.3%, compared with 4.3% for the 2-patch technique, p = 0.0264, with excellent freedom from reoperation rate. At reoperation right ventricular-pulmonary artery (RV-PA) conduits managed 29 patients and 3 had supravalvar patch enlargement. Hospital mortality was 5.4% (2 of 37). Twenty-five patients (68%) were in New York Heart Association functional class I to II at end of the follow-up, and none required further interventions.

CONCLUSIONS

Redo rate following complete correction of tetralogy of Fallot was 7.4%. Right ventricular outflow tract pathology was the dominant reason for reoperations (86%). At reoperation, RV-PA conduits was the most frequently used technique. Reoperation was efficient in reducing the RV-PA gradient, had low hospital and late mortality. A 2-patch valvar-supravalvar enlargement at first operation reduced the risk for redo in long-term follow-up.