Surgical repair of Tetralogy of Fallot – Long-term outcomes into the second decade after transannular patch repair and annulus-sparing patch repair

Objectives Different techniques are used to perform repair of Tetralogy of Fallot (TOF), depending on the development of the pulmonary valve and the degree of the right ventricular outflow tract obstruction.

Methods All patients who underwent TOF repair with either an annulus-sparing patch or a transannular patch (TAP) between January 1995 and April 2021 were included in this retrospective chart review. Mortality was cross-checked with the national health insurance. Survival and competing-risks analyses were conducted to report on long-term outcomes.

Results One-hundred-fifty patients (50.7% male; median age at surgery 5.8 months; 28.7% staged repair with primary shunt palliation) underwent TOF repair with annulus-sparing patch (43.3%; 65/150) or TAP (56.7%; 85/150) respectively. Median follow-up was 5.4 years (IQR 0.1-16.4 years) with a maximum follow-up of 26.7 years. Six deaths (4 early deaths and 2 late deaths) occurred and Kaplan-Meier estimated survival was 96.3% at 5 years, 94.3% at 15 years and 20 years. The cumulative incidence of pulmonary valve replacement was significantly higher (p = 0.011) in the TAP group than in the annulus-sparing patch group with 58.9% (95% CI 37.8-75) and 40.2% (95% CI 21.3-58.5) at 20 years respectively. Also, the cumulative incidence of any Fallot-related reintervention (percutaneous and surgical) was significantly higher (p = 0.007) in the TAP group.

Conclusion Early survival rates and long-term survival up to the second postoperative decade after TOF repair show good results. There was no difference in survival between patients with TAP and annulus-sparing patch. TAP repair was associated with an increased need for Fallot-related reintervention and for pulmonary valve replacement.