Outcomes in Young Adults with Tetralogy of Fallot and Pulmonary Annular Preserving or Transannular Patch Repairs

Background Early surgical tetralogy of Fallot (ToF) repair involved patching across the pulmonic annulus (TAP), which resulted in severe pulmonic regurgitation. Long-term outcome improvements were anticipated with modifications that preserved the pulmonic annulus (AP). The objective of the present study was to evaluate need for late reintervention in adults with AP repair and those with TAP repair. Methods We conducted a retrospective review of adults (born 1981-1996) with childhood intra-cardiac ToF repairs at a tertiary care center. The primary cardiovascular outcome was need for re-intervention after primary intra-cardiac repair of tetralogy of Fallot. Secondary outcomes included a composite of death, heart failure or ventricular arrhythmias. Results Two hundred and thirty adults were included; 104 with AP repair and 126 with TAP repair. The median age at last follow up was 25 years (IQR 20, 28) and the median follow-up duration was 7.9 years (IQR 3.5, 12). Re-intervention of any type was significantly more common in the TAP group during both childhood and adulthood (72.2% TAP vs. 20.2% AP, HR 5.5, 95%CI 3.4-9.0, p Conclusion Patients who had annular preserving ToF repair had significantly fewer late re-interventions when compared to TAP repair, the majority of reinterventions were due to PVR. More long term follow-up is required.