Need of Transannular Patch in Tetralogy of Fallot Surgery Carries a Higher Risk of Reoperation but Has No Impact on Late Survival: Results of Fallot Repair in Finland

Objectives: Our study is a population-based evaluation of the long-term results after surgical repair for tetralogy of Fallot (TOF). All patients operated on in the country since the first procedure were identified via the Finnish research database of paediatric cardiac surgery and the Finnish population register. The follow-up was 99% completed due to comprehensive coverage of the registers.

Methods: The Finnish research database of paediatric cardiac surgery, surgical logs, diagnosis cards and computer files of the hospitals were used for data collection. The Finnish Population Register Center was used to obtain current patient status and dates of death and emigration.

Results: A total of 600 patients underwent surgical repair of TOF before the age of 15 years during the 46-year period from 1962 to 2007. The mean follow-up time was 23 ± 12.1 years; 513 (85%) patients were alive and living in Finland, 82 (14%) had died and 5 patients were lost to the follow-up (0.8%). A total of 40 patients (7%) died early (≤30 days) and 42 (7%) died late (>30 days) after the surgical correction. During the last two decades the early mortality rate was 1.5% and no early deaths were observed after the year 2000. A transannular patch (TAP) was used in the reconstruction of the right ventricular outflow tract in 191 (32%) of these patients and had no influence on late mortality but the event-free survival was significantly inferior in these patients. If a primary palliation was performed before the correction, the late survival was significantly inferior when compared with patients without initial palliation. Also reoperation was more common in patients with primary palliation.

Conclusions: The long-term prognosis of surgically corrected TOF patients is good and has improved with each decade since the beginning of TOF surgery in Finland. Primary repair of tetralogy of Fallot predicts a lower mortality rate and longer freedom from reoperation when compared with two-stage repair. Need of a TAP in TOF surgery carries a higher risk of reoperation but has no impact on late survival.