Objective: To report our experience and results of late surgical correction of patients with
tetralogy of Fallot (TOF) in the context of a humanitarian collaboration program.
Material & Patients: Retrospective analysis of the perioperative course of all patients
undergoing correction of TOF after x years of age at the University Hospital Bern or the
University Children’s Hospital Rabat between November 2011 to November 2016.
Results: 25 children (mean age: 70.8 months, range: 23-163; 44% female) underwent total
correction of TOF. Two patients were initially palliated with a shunt with subsequent
correction after 108 and 24 months. Preoperative oxygen saturation was 84±12%; mean
hemoglobin was 147±31g/l. Preoperative mean RV/PA gradient was 84±32mmHg with a
Nakata index of 163.6±70.5mm2/m2. Large aorto-pulmonary collateral vessels (MAPCAs)
were observed in n=8 (32%), and n=6 (26%) underwent transcatheter closure just before
surgical correction. Presence of coronary abnormality in 28% of the cases (n=7). 96 %
underwent a valve-sparing correction. Early mortality was 0%; perioperative morbidities were
0%, stroke 0%, postoperative pacing 0% and no patient required an extracorporeal
membrane oxygenation. Mean duration of mechanical ventilation was 28.7±19.6h (range: 7-
76).
Last follow-up was 1 month due to the setting of program. Last echocardiography
demonstrated a mean RV/PA gradient of 34.6±14.8mmHg; LVEF >60% in all cases, with no
RV dysfunction. Postoperative saturation was 98% (range: 95-100%). A residual pulmonary
stenosis was light in n=7, moderate in n=10 patients. Concerning the residual subvalvular
pulmonary stenosis: moderate in n= 3. Finally, the supravalvular pulmonary stenosis was
light in n= 1, moderate in n=6 without any severe PV insufficiency. 1 patient underwent
reoperation for patch dehiscence, 1 patient underwent reoperation for recurrent pulmonary
stenosis. Length of stay was 11.7±4.5 days (4.8±2.4 days in ICU).
For 11 children, we have a 6-month follow-up exam which showed good results without any
need of reoperation or reintervention.
Conclusions: Late correction of TOF can be safely performed in older children with good
early postoperative results and low morbidity comparable to reported results for “timely”
correction in infants. A valve-sparing correction might be possible in majority of those
patients. Follow-up study for the evaluation of the development of right ventricular and
pulmonary valve dysfunction is needed and under way…