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The Annals of Thoracic Surgery, Vol 48, 783-791, Copyright © 1989 by The Society of Thoracic Surgeons
JK Kirklin, JW Kirklin, EH Blackstone, A Milano and AD Pacifico
Among 814 patients undergoing repair of tetralogy of Fallot with pulmonary
stenosis between 1967 and May 1986, transannular patching in the current
era was a weak risk factor for death early postoperatively (predicted
30-day mortality, 4% with a transannular patch and 1.4% without) and is not
a risk factor for instantaneous risk of death late postoperatively
(predicted 20-year survival including early death, 94% with a transannular
patch and 96.5% without). Ninety-six percent of surviving patients were in
New York Heart Association functional class I at last follow-up, and the
slight decline in this percentage as the interval between operation and
last follow-up lengthened could have been due to chance alone (p = 0.24)
and was no different in patients with a transannular patch. Transannular
patching was a risk factor for reoperation for pulmonary regurgitation late
postoperatively, but only a 7% incidence within 20 years is predicted when
mild residual stenoses are beyond the patch: the incidence rises to about
20% with important distal stenoses. Inferences from the study are relevant
to the indications for transannular patching and insertion of allograft
semilunar valves at the time of repair.
ARTICLES
Effect of transannular patching on outcome after repair of tetralogy of Fallot
Department of Surgery, University of Alabama, Birmingham School of Medicine and Medical Center 35294.
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