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Indications for reoperation late after correction of tetralogy of Fallot

Published online by Cambridge University Press:  11 May 2010

Theodor Tirilomis ,
Martin Friedrich ,
Dieter Zenker ,
Ralf G. Seipelt ,
Friedrich A. Schoendube  and
Wolfgang Ruschewski
Theodor Tirilomis*
Affiliation:
Department for Thoracic, Cardiac, and Vascular Surgery, University of Göttingen, Göttingen, Germany
Martin Friedrich
Affiliation:
Department for Thoracic, Cardiac, and Vascular Surgery, University of Göttingen, Göttingen, Germany
Dieter Zenker
Affiliation:
Department for Thoracic, Cardiac, and Vascular Surgery, University of Göttingen, Göttingen, Germany
Ralf G. Seipelt
Affiliation:
Department for Thoracic, Cardiac, and Vascular Surgery, University of Göttingen, Göttingen, Germany
Friedrich A. Schoendube
Affiliation:
Department for Thoracic, Cardiac, and Vascular Surgery, University of Göttingen, Göttingen, Germany
Wolfgang Ruschewski
Affiliation:
Department for Thoracic, Cardiac, and Vascular Surgery, University of Göttingen, Göttingen, Germany
*
Correspondence to: T. Tirilomis, MD, PhD, FETCS, Department for Thoracic, Cardiac, and Vascular Surgery, University of Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany. Tel: +49551396025; Fax: +49551396002; E-mail: theodor.tirilomis@med.uni-goettingen.de
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Abstract

Objective

Correction of tetralogy of Fallot has excellent long-term results. The present retrospective study investigates the indications for reoperation late after corrective surgery.

Methods

Data from 914 consecutive cases who underwent correction of tetralogy of Fallot in our department between 1960 and 2002 were retrospectively reviewed and analysed. In 91 patients, a total of 102 reoperations were performed late after repair.

Results

The mean time interval between corrective surgery and the first reoperation was 12.8 years. The main indication for reoperation was residual ventricular septal defect in nearly half of the cases, mostly isolated, but also in combination with a right ventricular outflow tract aneurysm or pulmonary stenosis. One-fourth of reoperated patients underwent a procedure on their pulmonary artery or pulmonary valve: replacement of pulmonary valve, replacement of primary implanted pulmonary artery conduits with or without concomitant surgery, and surgery for isolated peripheral pulmonary stenosis. The remaining indications were right ventricular outflow tract aneurysms and others. Aneurysms of the right ventricular outflow tract were seen mostly after the use of autologous – untreated – pericardial patch in 18 of 21 cases.

Conclusion

The number of reoperations for residual ventricular septal defect decreased during the study period. The primary use of conduits led to an increased number of reoperations for conduit exchange due to degeneration or failure. Use of an untreated autologous pericardial patch for enlargement of the right ventricular outflow tract should be avoided due to increased risk for aneurysm formation.

Keywords

Congenital cardiac diseasesurgerycyanotic defect
Type
Original Articles
Information
Cardiology in the Young , Volume 20 , Issue 4 , August 2010 , pp. 396 - 401
Copyright
Copyright © Cambridge University Press 2010

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References

1. Bertranou, EG, Blackstone, EH, Hazelrig, JB, Turner, ME, Kirklin, JW. Life expectancy without surgery in tetralogy of Fallot. Am J Cardiol 1978; 42: 458–466.CrossRefGoogle ScholarPubMed
2. Kirklin, JW, DuShane, JW, Patrick, RT, et al. Intracardiac surgery with the aid of a mechanical pump-oxygenator system (Gibbon type): report of eight cases. Proc Staff Meet Mayo Clin 1955; 30: 201–206.Google ScholarPubMed
3. Lillehei, CW, Varco, RL, Cohen, M, Warden, HE, Patton, C, Moller, JH. The first open-heart repairs of ventricular sepral defect, atrioventricular communis, and tetralogy of Fallot using extracorporeal circulation by cross-circulation: a 30-year-follow-up. Ann Thorac Surg 1986; 41: 4–21.CrossRefGoogle Scholar
4. Lillehei, CW, Varco, RL, Cohen, M, et al. The first open heart corrections of tetralogy of Fallot. A 26–31-year follow-up of 106 patients. Ann Surg 1986; 204: 490–502.CrossRefGoogle ScholarPubMed
5. Niwa, K, Hamada, H, Nakazawa, M, et al. Mortality and risk factors for late deaths in tetralogy of Fallot: the Japanese Nationwide Multicenter Survey. Cardiol Young 2002; 12: 453–460.CrossRefGoogle Scholar
6. Boening, A, Scheewe, J, Paulsen, J, et al. Tetralogy of Fallot: influence of surgical technique on survival and reoperation rate. Thorac Cardiovasc Surg 2001; 49: 355–360.CrossRefGoogle ScholarPubMed
7. Groh, MA, Meliones, JN, Bove, EL, et al. Repair of tetralogy of Fallot in infancy: effect of pulmonary artery size on outcome. Circulation 1991; 84 (Suppl III): III206–III212.Google ScholarPubMed
8. Pigula, FA, Khalil, PN, Mayer, JE, del Nido, PJ, Jonas, RA. Repair of tetralogy of Fallot in neonates and young infants. Circulation 1999; 100 (Suppl II): II157–II161.CrossRefGoogle ScholarPubMed
9. Norgaard, MA, Lauridsen, P, Hevind, M, Pettersson, G. Twenty-to-thirty-seven-year follow-up after repair for tetralogy of Fallot. Eur J Cardiothorac Surg 1999; 16: 125–130.CrossRefGoogle ScholarPubMed
10. d’Udekem, Y, Ovaert, C, Grandjean, F, et al. Tetralogy of Fallot. Transannular and right ventricular patching eqaully affect late functional status. Circulation 2000; 102 (Suppl III): III116–III122.CrossRefGoogle Scholar
11. Cesnjevar, R, Harig, F, Raber, A, et al. Late pulmonary replacemnt after correction of Fallot’s tetralogy. Thorac Cardiovasc Surg 2004; 52: 23–28.Google Scholar
12. Rosti, L, Murzi, B, Colli, AM, et al. Mechanical valves in the pulmonary position: a reappraisal. J Thorac Cardiovasc Surg 1998; 115: 1074–1079.CrossRefGoogle ScholarPubMed
13. Jonas, RA, Freed, MD, Mayer, JEJ, Castaneda, AR. Long-term follow-up of patients with synthetic right heart conduits. Circulation 1985; 72 (Part 2): II77–II83.Google ScholarPubMed
14. Niwaya, K, Knott-Craig, CJ, Lane, MM, Chandrasekaren, K, Overholt, ED, Elkins, RC. Cryopreserved homograft valves in the pulmonary position: risk analysis for intermediate-term failure. J Thorac Cardiovasc Surg 1999; 117: 141–147.CrossRefGoogle ScholarPubMed