The following is a summary of “Survival and Freedom From Reinterventions in Patients With Repaired Tetralogy of Fallot: Up to 42‐Year Follow‐Up of 917 Patients,” published in the October 2023 issue of Cardiology by Gebauer et al.

The study focuses on assessing the long-term outcomes of tetralogy of Fallot repair by examining an extensive, unbiased cohort of surgically treated individuals across the country. This retrospective analysis scrutinized consecutive patients under 18 years of age who underwent tetralogy of Fallot repair at a single nationwide pediatric cardiac center. The primary endpoints encompass mortality from any cause and the requirement for subsequent surgical or catheter-based reinterventions. 

Cox regression analysis was employed to discern associated risk factors. The analysis involved 917 patients, of whom 56.3% were male. Staged repair procedures were carried out in 16.9% of cases. Notably, early mortality, recorded in 2.62% of patients (24/917), was confined to the initial surgical eras, while late mortality accounted for 4.5% (40/893 patients). The survival probabilities at 10, 20, and 30 years post-repair were 95.1%, 93.8%, and 91.9%, respectively. Factors such as the early surgical era (P=0.013) and subsequent surgical/catheter reinterventions (P<0.001) were identified as independent predictors of late mortality. A total of 487 reinterventions post-initial repair were performed in 253 patients (27.6%), with pulmonary artery revalvulation being the most common (196/917 patients, 21.4%). The probability of remaining free from the first reintervention was 89.0%, 73.3%, and 55.1% at 10, 20, and 30 years after the primary repair, respectively. The type of initial repair, particularly transannular repair, was associated with the need for pulmonary artery revalvulation (P<0.001). Additionally, patients who underwent staged repair exhibited a higher likelihood of requiring reinterventions on pulmonary arteries (P<0.001).

In conclusion, the nationwide cohort analysis revealed that tetralogy of Fallot repair boasted a favorable survival rate exceeding 90% at the 30-year mark. Importantly, each subsequent reintervention significantly elevated the risk of mortality. Furthermore, the nature of the initial repair procedure played a pivotal role in predicting the necessity for specific surgical or catheter-based reinterventions.

Source: ahajournals.org/doi/10.1161/JAHA.121.024771