A 10 - YEAR EXPERIENCE WITH SURGICAL MANAGEMENT OF TETRALOGY OF FALLOT: EXPERIENCE IN APPLYING UNTREATED AUTOLOGOUS PERICARDIUM IN THE REPAIR

Since the first successful repair of tetralogy of Fallot (TOF) by Lillehei and colleagues in 1954 -several reports have documented the excellent long-term prognosis for these patients. So we decided to report our surgical experience during a ten-year period. In addition the proposal that repair of ventricular septal defect (VSD) in TOF could be done with untreated autologous pericardial patch was studied.
To assess.these results we reviewed our 10-year experience with 362 patients undergoing operation by one surgeon and at one institution.Mean follow up was 29.2 months (range 2- 120 months). The mean age of our total series of 362 patients was 10.4±5.2 years, whichis higher than the reports from developed countries. Primary complete repair was done in 311 patients (85.9%) and a staged repair in 51 patients(14%).
At follow up 99% of our patients were in New York Heart Association(NYHA) class I and II. We found transannular patch aneurysm in 1.5%, residual pulmonary stenosis in 14%, severe pulmonary incompetence in 0.6%, right bundle branch block (RBBB) in 42.3%, complete heart block in 2.4% and residual VSD, which also included hemodynamically unimportant leakage in 18.3%. Reintervention was needed in 3.9% (13/333 patients). The type of patch which was used for repair of VSD was Dacron in 38.6%, Gore-Tex (PTFE) in 36.1% and untreated autologous pericardiumin 23.7% of patients. The results were studied and there was no more residual VSD, aneurysm or calcification with pericardial patch and statistical analysis also confirmed that. Hospital mortalitywas 8.01% (29/362 patients). The variables such as age at repair (over 14 years old), use of transannular patch, staged repair, atrial septal defect (ASD) or patent foramen ovale (PFO) closure, hemoglobin over 19 gldL and arterial oxygen pressure (PaOz) below 45 mmHg at the time of operation were studied. The univariable and multivariable statistical analysis showed a significant correlation between ASD closure and death (P value = 0.04). For hospital survivors, there were only 2 late deaths at follow up.
Our study has shown that complications(except RBBB), need for reoperation and mortality are very similar to first world reports. On the other hand the untreated autologous pericardial patch has shown to be a safe and economica lalternative for VSD closure, provided that the patch is properly sized.