2020-04-01
Long-term follow-up after transatrial-transpulmonary repair of tetralogy of Fallot: influence of timing on outcome
Publication
Publication
European Journal of Cardio-Thoracic Surgery , Volume 57 - Issue 4 p. 635- 643
OBJECTIVES: Our goal was to report the long-term serial follow-up after transatrial-transpulmonary repair of tetralogy of Fallot (TOF) and to describe the influence of the timing of the repair on outcome. METHODS: We included all patients with TOF who had undergone transatrial-transpulmonary repair between 1970 and 2012. Records were reviewed for patient demographics, operative details and events during the follow-up period (death, pulmonary valve replacement, cardiac reinterventions and hospitalization/intervention for arrhythmias). In patients with elective early primary repair of TOF after 1990, a subanalysis of the optimal timing of TOF repair was performed. RESULTS: A total of 453 patients were included (63% male patients; 65% had transannular patch); 261 patients underwent primary elective repair after 1990. The median age at TOF repair was 0.7 years (25th-75th percentile 0.3-1.3) and decreased from 1.7 to 0.4 years from before 1990 to after 2000, respectively (P < 0.001). The median follow-up duration after TOF repair was 16.8 years (9.6-24.7). Events developed in 182 (40%) patients. In multivariable analysis, early repair of TOF (<6 months) [hazard ratio (HR) 3.06; P < 0.001] and complications after TOF repair (HR 2.18; P = 0.006) were found to be predictive for an event. In a subanalysis of the primary repair of TOF after 1990, the patients (n = 125) with elective early repair (<6 months) experienced significantly worse event-free survival compared to patients who had elective repair later (n = 136). In multivariable analysis, early repair (HR 3.00; P = 0.001) and postoperative complications (HR 2.12; P = 0.010) were associated with events in electively repaired patients with TOF. CONCLUSIONS: Transatrial-transpulmonary repair of TOF before the age of 6 months may be associated with more events during the long-term follow-up period.
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| doi.org/10.1093/ejcts/ezz331, hdl.handle.net/1765/125827 | |
| European Journal of Cardio-Thoracic Surgery | |
| Organisation | Department of Pediatrics |
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van den Bosch, E., Bogers, A., Roos-Hesselink, J., van Dijk, A., van Wijngaarden, M.H.E.J. (Marie H E J), Boersma, E., … Helbing, W. (2020). Long-term follow-up after transatrial-transpulmonary repair of tetralogy of Fallot: influence of timing on outcome. European Journal of Cardio-Thoracic Surgery, 57(4), 635–643. doi:10.1093/ejcts/ezz331 |
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