Adult tetralogy - surgical experience at our institute

Objectives: To review our experience in patients with Tetralogy of Fallot aged above 12 years operated at our institute from August 2006 to July 2016.To study the morbidity and mortality associated with surgery in adulthood. We also tried to identify the risk factors for early and late death, adequacy of repair, and need for re-operation and also to compare the difference in quality of life and survival following corrective surgery. Methods: A total of 74 patients, 12 years of age and above with a diagnosis of Tetralogy of Fallot were operated up on at our institute between August 2006 and July 2016. A retrospective review of the hospital inpatient and outpatient charts for the age, sex, weight, presence of associated conditions, presenting symptoms, preoperative NYHA class, preoperative risk factors, echocardiogram reports, cardiac catheterization reports and operative details including time of aortic crossclamp, cardio- pulmonary bypass time, post operative need for inotropes, ventilation, post operative complications, post operative follow up etc was performed. Only patients with an anatomy typical of Tetralogy of Fallot were included in the study. 49 % of the patients were below the age of 20 and only 18% in the study group were above 30 years. 74 patients underwent surgery for Adult Tetralogy. All patients underwent either total correction (n=65) or palliation (n=9). There were 52 males and 22 females.
Results: Out of the 65 patients who had corrective surgery 43 patients underwent Transannular patch,13 patients had Right Ventricular patch only, 8 patients had Rastelli operation and one patient had Infundibular resection with ventricular septal defect closure. The immediate postoperative mortality was as follows. 9 patients died after total correction out of this 7 patients had underwent transannular patch including two patients who had aortic valve replacement and one each of Rastelli and RV patch. All the patients followed up were either in NYHA class I or II. None of our surviving patients underwent any reoperations for residual stenosis or pulmonary regurgitation. None of the patients were cyanotic and all had marked reduction in clubbing. Most were not on medications except in patients who underwent Rastelli who were on aspirin and prophylactic antibiotics during dental care and intercurrent infections.