Long-Term Outcomes of Patients with Tetralogy of Fallot Repaired in Young Infants and Toddlers

Background: Total repair of tetralogy of Fallot (TOF) during young infancy had been recently advocated, but recent outcomes leave this question undecided. Methods: Between 1992 and 2002, 259 consecutive TOF patients received total repair in our hospital. To avoid confounding by previous shunt operations, we excluded those patients receiving staged shunt operation in the following analysis. Therefore, a total of 217 TOF patients who received one stage total repair before age 3 in our hospital were enrolled (early group: 38 patients 0-6 months old; late group: 179 patients 6 months-3 years old). We reviewed the medical records and confirmed the patients’ survival status from the National Health Database. Results: Baseline characteristics showed fewer emergent operations (1.7% vs. 13.2%, p = 0.005) and fewer transannular patches required (70.9% vs. 86.8%, p = 0.029) in the late group. However, the early group had longer intubation periods and intensive care stays. After the 1994 patient-years follow-up, the 10-year actuarial survival and reintervention-free survival rate was 97.4% and 89.4%, respectively in the early group, and 95.5% and 93.5% respectively in late group, which showed no statistically significant difference. The major risk factor for reintervention was small pulmonary artery size. Severe pulmonary regurgitation correlated with transannular patch, which tended to be higher in the early group. Conclusion: Although patients with TOF repaired within first 6 months of life had prolonged postoperative recovery and an increased chance of transannular patch usage, outcomes were comparable to those patients with TOF repaired later. Therefore, symptomatic infants can receive total repair of TOF early to avoid the need for use of a palliative shunt. However, when total repair is undertaken on an elective basis, the procedure may be delayed until the patient is older than 6 months of age.