Long-Term Outcome in Patients Undergoing Surgical Repair of Tetralogy of Fallot

Although corrective surgery for tetralogy of Fallot has been available for more than 30 years, the occurrence of late sudden death in patients in whom surgery was apparently successful remains worrisome. We studied long-term survival among 163 patients who survived 30 days after complete repair of tetralogy of Fallot, examining follow-up hospital records and death certificates when relevant. The overall 32-year actuarial survival rate among all patients who survived surgery was 86 percent, as compared with an expected rate of 96 percent in a control population matched for age and sex (P<0.01). Thirty-year actuarial survival rates were calculated for the patient subgroups. The survival rates among patients less than 5 years old, 5 to 7 years old, and 8 to 11 years old were 90, 93, and 91 percent, respectively – slightly less than the expected rates (P<0.001, P = 0.06, and P = 0.02). Among patients 12 years old or older at the time of surgery, the survival rate was 76 percent, as compared with an expected rate of 93 percent (P<0.001). The performance of a palliative Blalock-Taussig shunt procedure before repair, unlike the performance of a Waterston or Potts shunt procedure, was not associated with reduced long-term survival, nor was the need for a transannular patch at the time of surgery. Independent predictors of long-term survival were older age at operation (P = 0.02) and a higher ratio of right ventricular to left ventricular systolic pressure after surgery (P = 0.008). Late sudden death from cardiac causes occurred in 10 patients during the 32-year period. Among patients with surgically repaired tetralogy of Fallot, the rate of long-term survival after the postoperative period is excellent but remains lower than that in the general population. The risk of late sudden death is small., Tetralogy of Fallot (obstruction of right ventricular outflow, ventricular septal defect, right ventricular hypertrophy, and an overriding aorta) is the commonest cause of cyanotic congenital heart disease worldwide. It is estimated to occur in approximately 2700 infants per year born in the United States¹. Studies of the late results of surgery²–⁵ have documented a favorable long-term outcome in most patients⁶. Several authors have drawn attention to the unexpected occurrence of sudden death from cardiac causes both early and late after apparently successful corrective surgery,⁷,⁸ although the incidence of sudden death is not as high as in…