Contemporary Outcome following intervention for Tetralogy of Fallot

Tetralogy of Fallot (ToF) is the most common cyanotic congenital heart disease, frequently diagnosed prenatally which enables parental education on the postnatal course. To enhance understanding, we reviewed 18 years of our institutional outcomes for patients with classic ToF. There were 410 patients of whom 233/410 (56.8%) were diagnosed prenatally. A genetic abnormality was diagnosed in 38/410 (9.3%), most commonly 22q11.2 microdeletion (43.6%). There were 10/410 (2.4%) death in the neonatal period prior to any cardiac intervention. Prior to complete ToF repair, 62/400 (15.5%) of patients required cardiac procedures, in 15 in the first week after birth. Babies with an antenatal diagnosis were more likely to require at least one procedure before complete ToF repair than those with a postnatal diagnosis (p = 0.039). The shortest mean hospital stays were associated with right outflow tract and arterial duct and stents, at 5 days and 4 days respectively. Complete ToF repair was undertaken in 396/410 at a median age of 6 months (IQR: 4.0–8.0 months), with a 30-day postoperative survival rate of 99.5%. Following complete surgical repair, reintervention was required in 25%; 3.3% at 30 days, 10.6% at 1 year, and 19.2% at 5 years. The freedom from reintervention was 89.4% after 1 year and 80.8% after 5 years. There were no deaths beyond 2.5 years post-repair. In conclusion, ToF can be repaired with a low procedural mortality rate and promising long-term survival outcomes but there may be pre-procedural deaths and there may be a likelihood of requiring reinterventions during follow up.