- After tetralogy of Fallot (TOF) repair, transplant-free survival rates up to 25 years postsurgery are quite high, well above 90%.
- Mortality risk seems to peak in the short term following the repair.
- Some repair-related, possibly modifiable risk factors affect survival.
Why this matters
- Accompanying editorial says the results of this “robust analysis” will add to the understanding necessary to optimize strategies for TOF repair in infants.
- Editorial: The findings highlight the importance of intensive postdischarge care.
- Mortality risk is highest within period after the repair.
- Risk factors for in-hospital mortality include:
- Weight 12.53 (95% CI, 3.91-40.15).
- 1982-1989 surgical era: OR, 6.15 (95% CI, 3.32-11.41).
- Survival at the following timepoints was:
- 1 year: 98.6%;
- 5 years: 97.8%;
- 10 years: 97.1%;
- 20 years: 95.5%; and
- 25 years: 94.5%.
- Mortality risk increased with (adjusted HRs; 95% CIs):
- Staged repair: 2.68 (1.59-4.49);
- Non-valve-sparing procedure: 3.76 (1.53-9.91);
- Genetic abnormality, early or late postop: 3.64 (2.05-6.47) and 4.41 (2.62-7.44), respectively.
- Most postrepair deaths were TOF-related.
- Retrospective, multicenter, US-based registry cohort (n=3894), enrolled 1982-2003.
- Outcome: transplant-free survival early ((≥6 years) after repair.
- Funding: NIH.
- Some deaths possibly misclassified.