After tetralogy of Fallot repair, long-term survival is quite high

  • Smith CA & al.
  • JAMA Cardiol
  • 19 Dec 2018

  • curated by Emily Willingham, PhD
  • Clinical Essentials
Access to the full content of this site is available only to registered healthcare professionals. Access to the full content of this site is available only to registered healthcare professionals.

Takeaway

  • 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.

Key results

  • 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.

Study design

  • Retrospective, multicenter, US-based registry cohort (n=3894), enrolled 1982-2003.
  • Outcome: transplant-free survival early ((≥6 years) after repair.
  • Funding: NIH.

Limitations

  • Some deaths possibly misclassified.

Please confirm your acceptance

To gain full access to GPnotebook please confirm:

By submitting here you confirm that you have accepted Terms of Use and Privacy Policy of GPnotebook.

Submit