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

Early surgical tetralogy of Fallot (ToF) repair involved patching across the pulmonic annulus (transannular patch [TAP] repair), which resulted in severe pulmonic regurgitation. Long-term outcome improvements were anticipated with modifications that preserved the pulmonic annulus (annulus-preserving [AP] repair). The objective of the present study was to evaluate the need for late reintervention in adults with AP repair and those with TAP repair. We conducted a retrospective review of adults (born 1981-1996) with childhood intracardiac ToF repairs at a tertiary care center. The primary cardiovascular outcome was need for reintervention after primary intracardiac repair of ToF. Secondary outcomes included a composite of death, heart failure, and ventricular arrhythmias. Two hundred thirty adults were included: 104 with AP repair and 126 with TAP repair. The median age at last follow up was 25 years (interquartile range [IQR] 20-28) and the median follow-up duration was 7.9 years (IQR 3.5-12). Reintervention 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 < 0.001). Pulmonary valve replacement (PVR) was almost 6 times more likely in adults with TAP repair (65.1% TAP vs 16.3% AP, HR 5.7, 95% CI 3.4-9.7; P < 0.001). Patients who had AP ToF repair had significantly fewer late reinterventions compared with TAP repair, with the majority of reinterventions due to PVR. More long-term follow-up is required. La réparation chirurgicale précoce de la tétralogie de Fallot (TF) exigeait un patch dans l’anneau pulmonaire (réparation par patch transannulaire [PTA]), qui entraînait une régurgitation pulmonaire grave. Les modifications qui permettaient de préserver l’anneau pulmonaire (la réparation avec préservation de l’anneau [PA]) laissaient anticiper l’amélioration à long terme des critères de jugement. L’objectif de la présente étude était d’évaluer la nécessité de réintervention tardive chez les adultes qui subissaient une réparation avec PA et ceux qui subissaient une réparation par PTA. Nous avons mené une revue rétrospective auprès d’adultes (nés entre 1981-1996) qui avaient subi des réparations intracardiaques de la TF durant l’enfance dans un centre de soins tertiaires. Le principal critère de jugement cardiovasculaire était le besoin de réintervention après la réparation intracardiaque primaire de la TF. Les critères de jugement secondaires incluaient un critère compo