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Long-term Prognosis (15 to 26 Years) after Repair of Tetralogy of Fallot: I. Survival and Symptomatic Status

1984; Elsevier BV; Volume: 38; Issue: 2 Linguagem: Inglês

10.1016/s0003-4975(10)62224-2

1552-6259

Amnon Rosenthal, Douglas M. Behrendt, Herbert Sloan, Pauline Ferguson, Sandy M. Snedecor, M. Anthony Schork,

Coronary Artery Anomalies

One hundred eighty-two patients with tetralogy of Fallot repaired before or during 1967 were studied by interview, physical examination, and noninvasive testing.Twenty were excluded from the final analysis because review of cineangiograms and operative reports disclosed that they had had double-chambered right ventricle rather than tetralogy of Fallot.On follow-up ranging from 15 to 26 years (mean, 20.2 years), there were 86 patients in New York Heart Association Functional Class I, 53 in Class 11, 5 in Class 111, and none in Class IV.There were 9 late deaths.Functional classification was not ascertained in the remaining 9 patients.Cumulative survival at 25 years postoperatively was 94.4%.There was no significant relationship between survival and year of operation, age at operation, sex, or presence of a prior shunt.The 9 late deaths occurred between 6 and 23 years after operation and were due to late-onset complete heart block in 2 patients, congestive failure in 4, suicide in 1, accident in 1, and an unknown cause in 1.We conclude that long-term survival after repair of tetralogy of Fallot is excellent and not influenced by prior shunt.The success of surgical repair in patients with tetralogy of Fallot must be measured by the long-term survival and psychosocial adjustment made by patients within the community in which they live, not just by immediate operative survival or early postoperative hemodynamic results.At the University of Michigan Medical Center, the first patient to have successful repair of tetralogy of Fallot underwent operation in 1957.In 1968, operative and postoperative follow-up results in 182 survivors of 215 operations were reported [l].The present study was undertaken to determine the status of these survivors 15 to 26 years after repair.This initial report addresses three specific issues: (1) overall clinical status as assessed by the New York Heart Association Functional Classification [2], (2) long-term survival and factors that may influence it, and (3) cause or causes of premature late deaths.Subsequent reports will deal with the hemodynamic and electrocardiographic residua of repair and