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Survival and clinical results up to 26 years after repair of tetralogy of Fallot.

Repair of tetralogy of Fallot was performed on 165 patients (median age 7 years, range 4 months-54 years) in 1966-1976. The 30-day mortality rate was 15%. High postrepair right ventricular/left ventricular pressure ratio (P(RV/LV)) was a predictor of early mortality. Complete atrioventricular block of varying duration, though associated with 42% of the early deaths, was not an independent risk factor in multivariate analysis. The 20-year survival rate (excluding early deaths) was 84%. Reoperation was done in ten patients. Of the 16 late deaths, eight were sudden. Old age at repair and use of transannular patch correlated with risk of late death. Complete atrioventricular block, acyanosis, year of surgery, sex, and P(RV/LV) did not significantly influence long-term survival. Follow-up (median 19, range 13-26 years) comprised 110 survivors, 95% of whom were asymptomatic, 77% in employment, 65% had participated in school athletics and 58% regularly exercised, but 40% did not have regular medical examinations. Operation at age 3-5 years had the most favourable prognosis.