Among 814 patients undergoing repair of tetralogy of Fallot with pulmonary stenosis between 1967 and May 1986, transannular patching in the current era was a weak risk factor for death early postoperatively (predicted 30-day mortality, 4\% with a transannular patch and 1.4\% without) and is not a risk factor for instantaneous risk of death late postoperatively (predicted 20-year survival including early death, 94\% with a transannular patch and 96.5\% without). Ninety-six percent of surviving patients were in New York Heart Association functional class I at last follow-up, and the slight decline in this percentage as the interval between operation and last follow-up lengthened could have been due to chance alone (p = 0.24) and was no different in patients with a transannular patch. Transannular patching was a risk factor for reoperation for pulmonary regurgitation late postoperatively, but only a 7\% incidence within 20 years is predicted when mild residual stenoses are beyond the patch: the incidence rises to about 20\% with important distal stenoses. Inferences from the study are relevant to the indications for transannular patching and insertion of allograft semilunar valves at the time of repair.

Effect of transannular patching on outcome after repair of tetralogy of Fallot.

MILANO, Aldo Domenico;
1989-01-01

Abstract

Among 814 patients undergoing repair of tetralogy of Fallot with pulmonary stenosis between 1967 and May 1986, transannular patching in the current era was a weak risk factor for death early postoperatively (predicted 30-day mortality, 4\% with a transannular patch and 1.4\% without) and is not a risk factor for instantaneous risk of death late postoperatively (predicted 20-year survival including early death, 94\% with a transannular patch and 96.5\% without). Ninety-six percent of surviving patients were in New York Heart Association functional class I at last follow-up, and the slight decline in this percentage as the interval between operation and last follow-up lengthened could have been due to chance alone (p = 0.24) and was no different in patients with a transannular patch. Transannular patching was a risk factor for reoperation for pulmonary regurgitation late postoperatively, but only a 7\% incidence within 20 years is predicted when mild residual stenoses are beyond the patch: the incidence rises to about 20\% with important distal stenoses. Inferences from the study are relevant to the indications for transannular patching and insertion of allograft semilunar valves at the time of repair.
1989
Child, Follow-Up Studies, Humans, Postoperative Period, Pulmonary Valve Stenosis; surgery, Reoperation, Risk Factors, Survival Analysis, Survival Rate, Tetralogy of Fallot
File in questo prodotto:
File Dimensione Formato  
Milano_Kirklin-1989.pdf

accesso aperto

Tipologia: Documento in Post-print
Licenza: Dominio pubblico
Dimensione 1.18 MB
Formato Adobe PDF
1.18 MB Adobe PDF Visualizza/Apri

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11562/478447
Citazioni
  • ???jsp.display-item.citation.pmc??? 16
  • Scopus 163
  • ???jsp.display-item.citation.isi??? 132
social impact