Surgical management of tetralogy of Fallot in the first year of life

Background. The surgical approach to tetralogy of Fallot (TOF) continues to evolve and now many centers favor early repair for TOF. Methods. Our experience includes 82 consecutive patients less than 1 year old with TOF (n = 74) and TOF with pulmonary atresia (n = 8) who were operated on between January 1992 and March 1998. Mean age at repair was 5.2 ± 1.2 months and mean weight was 4.5 ± 0.4 kg. Seven patients (anomalous left anterior descending artery [n = 1], pulmonary atresia with hypoplastic pulmonary arteries [n = 6]), underwent palliative procedures in the neonatal period followed by complete repair. Forty-nine patients (59%) were symptomatic (severe cyanosis or hypoxic spells), and 33 patients (41%) were asymptomatic. A combined transatrial-transpulmonary approach was employed in 28 patients (34%), and transannular patch or conduit for reconstruction of the right ventricular outflow tract (RVOT) was required in 54 patients (66%). The mean Nakata index was 160 ± 25 mm²/m². Results. There were no hospital deaths. Mean post-repair peak right ventricular/systemic pressure ratio was 0.48 ± 0.1. There were no late deaths or reoperations during a mean follow-up of 23 ± 5 months. All patients are currently asymptomatic and in New York Heart Association class 1. Postoperative evaluation by two-dimensional and Doppler echocardiography or cardiac catheterization showed minimal pulmonary artery stenosis with a mean pressure gradient of 15 ± 6 mm Hg across the RVOT. Conclusions. Our experience suggests that early repair of TOF can yield excellent results and initial palliation does not preclude early complete repair.