LATE RIGHT HEART RECONSTRUCTION FOLLOWING REPAIR OF TETRALOGY OF FALLOT

Symptomatic patients (22) underwent 28 reoperative procedures after initial surgical repair of tetralogy of Fallot. Of the patients, 16 had unfavorable anatomy of the right ventricular outflow tract (RVOT) or pulmonary artery noticed at the time of initial repair. Pulmonary or tricuspid valve replacement, or both , utilizing a xenograft bioprosthesis was performed in 1 of the 22 initial repairs, 7 of the 22 first reoperations and 5 of the 6 second reoperations. Fourteen patients received transannular RVOT patches. The interval between the 1st and 2nd reoperations for 6 patients who required 2 late reconstructive procedures was 5.8 yr. No operative deaths occurred. There were 2 late deaths (1 sudden and 1 due to aspiration). Actuarial survival probability (.+-. standard error of the mean) 16 yr after initial repair was 72 .+-. 21%. Of the 20 current survivors in the present series, 18 are completely asymptomatic without physical restrictions; the other 2 are considered to be in New York [USA] Heart Association Functional Class II. No xenograft bioprosthetic dysfunction occurred, but cumulative valve follow-up is limited (13 patient-years). In selected patients earlier pulmonary or tricuspid valve replacement or both can provide some degree of protection against recurrent deterioration.