Late reoperations after repair of tetralogy of Fallot

Twenty-two patients underwent 23 late reoperations after totalcorrection of tetralogy of Fallot from 1965 to 1990. Indications forreoperation included: isolated ventricular septal defect (VSD) in 9patients (41%), isolated right ventricular outflow tract (RVOT) obstructionin 3 patients (13.7%), VSD associated with a RVOT obstruction in 7 patients(31.8%), aneurysm of the pericardial RVOT patch in 1 patient (4.5%), aorticinsufficiency with a residual VSD in 1 patient (4.5%), and tricuspidregurgitation in 1 patient (4.5%). The reoperation consisted of closure ofa residual VSD in 17 patients, relief of a RVOT gradient in 11, insertionof a RVOT valve in 4, tricuspid valve replacement in 1 (reoperated twice),aortic valve replacement in 1, and excision of a RVOT aneurysm in 1. Twopatients died in hospital (9%) but there were no early deaths in the 11patients reoperated upon after 1978. Mean follow-up period was 135 months.There were 2 late deaths. The actuarial 20-year survival was 87%. Of thesurviving patients, 16 (89%) were in New York Heart Association class I, 1(5.5%) was in class II, and one (5.5%) was in class III. One patientrequired a second reoperation for tricuspid bioprosthesis degeneration and1 patient had moderate recurrent RVOT gradient due to calcified pulmonarybioprosthesis. This study tends to support the policy of recommendingreoperation in the presence of surgically significant residual defects.Reoperation is associated with a low early mortality and good long-termresults.