Advertisement
Mayo Clinic Proceedings Home

Adults With Tetralogy of Fallot: Early Postoperative Outcomes and Risk Factors for Complications

      Abstract

      Objective

      To report the early postoperative outcomes in adults with tetralogy of Fallot (TOF) undergoing cardiac surgery and to identify patient factors associated with complications.

      Patients and Methods

      We performed a single-institution retrospective review of adults with TOF who underwent cardiac surgery from January 8, 2008, through June 21, 2018. Patients’ characteristics, preoperative imaging, surgical interventions, outcomes, and complications were analyzed.

      Results

      There were 219 adults with TOF (mean age, 40 years; range, 18-83 years; 88 [40%] female) in the study. Surgical interventions included repair or replacement of the pulmonary valve (n=199 [91%]), tricuspid valve (n=70 [32%]), mitral valve (n=13 [5.9%]), and aortic valve (n=8 [3.7%]). Three patients (1.4%) underwent first-time TOF repair. The 30-day mortality rate was 1.4% (n=3). Early postoperative complications occurred in 66 (30%) and included arrhythmias requiring treatment, dialysis requirement, liver dysfunction, respiratory failure, infection, reoperation, cardiac arrest, mechanical circulatory support, and death. Multivariate analysis found older age at current surgery (odds ratio [OR], 1.04 per year; 95% CI, 1.01 to 1.06; P<.001), longer cardiopulmonary bypass time (OR, 1.01 per minute; 95% CI, 1.01 to 1.02; P<.001), right ventricular systolic dysfunction (OR, 1.31; 95%, CI 1.02 to 1.69; P=.03), diabetes mellitus (OR, 3.50; 95% CI, 1.20 to 10.2; P=.02), and history of initial palliative surgery (OR, 1.99; 95% CI, 1.01 to 3.91; P=.05) as independent predictors of complications.

      Conclusion

      Surgical interventions for adult patients with TOF can be performed with low early morbidity and mortality. Clinical characteristics and preoperative testing parameters can predict risk for complications in the postoperative period.

      Abbreviations and Acronyms:

      CHD (congenital heart disease), CPB (cardiopulmonary bypass), ECMO (extracorporeal membrane oxygenation), EDV (end-diastolic volume), EF (ejection fraction), IQR (interquartile range), LV (left ventricular), MRI (magnetic resonance imaging), OR (odds ratio), POD (postoperative day), PVR (pulmonary valve replacement), RV (right ventricular), RVSP (right ventricular systolic pressure), TOF (tetralogy of Fallot), TR (tricuspid regurgitation)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Mayo Clinic Proceedings
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • van der Linde D.
        • Konings E.E.
        • Slager M.A.
        • et al.
        Birth prevalence of congenital heart disease worldwide: a systematic review and meta-analysis.
        J Am Coll Cardiol. 2011; 58: 2241-2247
        • Lillehei C.W.
        • Varco R.L.
        • 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
        • Smith C.A.
        • McCracken C.
        • Thomas A.S.
        • et al.
        Long-term outcomes of tetralogy of Fallot: a study from the Pediatric Cardiac Care Consortium.
        JAMA Cardiol. 2019; 4: 34-41
        • Gilboa S.M.
        • Devine O.J.
        • Kucik J.E.
        • et al.
        Congenital heart defects in the United States: estimating the magnitude of the affected population in 2010.
        Circulation. 2016; 134: 101-109
        • Nollert G.
        • Fischlein T.
        • Bouterwek S.
        • Böhmer C.
        • Klinner W.
        • Reichart B.
        Long-term survival in patients with repair of tetralogy of Fallot: 36-year follow-up of 490 survivors of the first year after surgical repair.
        J Am Coll Cardiol. 1997; 30: 1374-1383
        • Hickey E.J.
        • Veldtman G.
        • Bradley T.J.
        • et al.
        Late risk of outcomes for adults with repaired tetralogy of Fallot from an inception cohort spanning four decades.
        Eur J Cardiothorac Surg. 2009; 35 (discussion 164): 156-164
        • Attenhofer Jost C.H.
        • Connolly H.M.
        • Burkhart H.M.
        • et al.
        Tetralogy of Fallot repair in patients 40 years or older.
        Mayo Clin Proc. 2010; 85: 1090-1094
        • Murphy J.G.
        • Gersh B.J.
        • Mair D.D.
        • et al.
        Long-term outcome in patients undergoing surgical repair of tetralogy of Fallot.
        N Engl J Med. 1993; 329: 593-599
        • Gaies M.G.
        • Gurney J.G.
        • Yen A.H.
        • et al.
        Vasoactive-inotropic score as a predictor of morbidity and mortality in infants after cardiopulmonary bypass.
        Pediatr Crit Care Med. 2010; 11: 234-238
        • Mizuno A.
        • Niwa K.
        • Matsuo K.
        • et al.
        Survey of reoperation indications in tetralogy of Fallot in Japan.
        Circ J. 2013; 77: 2942-2947
        • Oechslin E.N.
        • Harrison D.A.
        • Harris L.
        • et al.
        Reoperation in adults with repair of tetralogy of Fallot: indications and outcomes.
        J Thorac Cardiovasc Surg. 1999; 118: 245-251
        • Ramanan S.
        • Sasikumar N.
        • Manohar K.
        • et al.
        Adult tetralogy repair: factors affecting early outcome in the current era.
        Asian Cardiovasc Thorac Ann. 2019; 27: 731-737
        • Khan I.
        • Tufail Z.
        • Afridi S.
        • Iqbal M.
        • Khan T.
        • Waheed A.
        Surgery for tetralogy of Fallot in adults: early outcomes.
        Braz J Cardiovasc Surg. 2016; 31: 300-303
        • Lamour J.M.
        • Kanter K.R.
        • Naftel D.C.
        • et al.
        The effect of age, diagnosis, and previous surgery in children and adults undergoing heart transplantation for congenital heart disease.
        J Am Coll Cardiol. 2009; 54: 160-165
        • Jain A.
        • Oster M.
        • Kilgo P.
        • et al.
        Risk factors associated with morbidity and mortality after pulmonary valve replacement in adult patients with previously corrected tetralogy of Fallot.
        Pediatr Cardiol. 2012; 33: 601-606
        • Anabtawi A.
        • Mondragon J.
        • Dodendorf D.
        • Laskey W.K.
        Late-stage left ventricular dysfunction in adult survivors of tetralogy of Fallot repair in childhood.
        Open Heart. 2017; 4: e000690
        • Knauth A.L.
        • Gauvreau K.
        • Powell A.J.
        • et al.
        Ventricular size and function assessed by cardiac MRI predict major adverse clinical outcomes late after tetralogy of Fallot repair.
        Heart. 2008; 94: 211-216
        • Geva T.
        • Gauvreau K.
        • Powell A.J.
        • et al.
        Randomized trial of pulmonary valve replacement with and without right ventricular remodeling surgery.
        Circulation. 2010; 122: S201-S208
        • Oosterhof T.
        • van Straten A.
        • Vliegen H.W.
        • et al.
        Preoperative thresholds for pulmonary valve replacement in patients with corrected tetralogy of Fallot using cardiovascular magnetic resonance.
        Circulation. 2007; 116: 545-551
        • Lee C.
        • Kim Y.M.
        • Lee C.H.
        • et al.
        Outcomes of pulmonary valve replacement in 170 patients with chronic pulmonary regurgitation after relief of right ventricular outflow tract obstruction: implications for optimal timing of pulmonary valve replacement.
        J Am Coll Cardiol. 2012; 60: 1005-1014
        • Stout K.K.
        • Daniels C.J.
        • Aboulhosn J.A.
        • et al.
        2018 AHA/ACC Guideline for the Management of Adults With Congenital Heart Disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.
        J Am Coll Cardiol. 2019; 73: e81-e192
        • Geva T.
        Indications for pulmonary valve replacement in repaired tetralogy of Fallot: the quest continues.
        Circulation. 2013; 128: 1855-1857
        • Silversides C.K.
        • Marelli A.
        • Beauchesne L.
        • et al.
        Canadian Cardiovascular Society 2009 Consensus Conference on the management of adults with congenital heart disease: executive summary.
        Can J Cardiol. 2010; 26: 143-150