Surgical repair of Tetralogy of Fallot - Long-term outcomes into the second decade after transannular patch repair and annulus-sparing patch repair.

Objectives: Different techniques are used to perform repair of Tetralogy of Fallot (TOF), depending on the development of the pulmonary valve and the degree of the right ventricular outflow tract obstruction. Methods: All patients who underwent TOF repair with either an annulus-sparing patch or a transannular patch (TAP) between January 1995 and April 2021 were included in this retrospective chart review. Mortality was cross-checked with the national health insurance. Survival and competing-risks analyses were conducted to report on long-term outcomes. Results: One-hundred-fifty patients (50.7% male; median age at surgery 5.8 months; 28.7% staged repair with primary shunt palliation) underwent TOF repair with annulus-sparing patch (43.3%; 65/150) or TAP (56.7%; 85/150) respectively. Median follow-up was 5.4 years (IQR 0.1-16.4 years) with a maximum follow-up of 26.7 years. Six deaths (4 early deaths and 2 late deaths) occurred and Kaplan-Meier estimated survival was 96.3% at 5 years, 94.3% at 15 years and 20 years. The cumulative incidence of pulmonary valve replacement was significantly higher ( Conclusion: Early survival rates and long-term survival up to the second postoperative decade after TOF repair show good results. There was no difference in survival between patients with TAP and annulus-sparing patch. TAP repair was associated with an increased need for Fallot-related reintervention and for pulmonary valve replacement.