Burden of Reintervention after Tetralogy of Fallot Repair: A joint pediatric and adult congenital experience over 30 years.

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Abstract Submission 

Shouka Parvin Nejad (1), Crystal Tran (1), Adriana Goraieb (1), Gazelle Halajha (1), Sangkavi Kuhan (1), Chun-Po Steve Fan (2), Sudipta Saha (2), David Barron (1), Erwin Oechslin Oechslin (3), Lee Benson (1), Rachel Vanderlaan (1)

(1) Hospital for Sick Children, Toronto, ON, Canada, (2) Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada, (3) Toronto General Hospital, Toronto, ON, Canada

Shouka Parvin Nejad    -  Contact Me
Hospital for Sick Children

Crystal Tran    -  Contact Me
Hospital for Sick Children

Adriana Goraieb    -  Contact Me
Hospital for Sick Children

Gazelle Halajha    -  Contact Me
Hospital for Sick Children

Sangkavi Kuhan    -  Contact Me
Hospital for Sick Children

Chun-Po Fan    -  Contact Me
Peter Munk Cardiac Centre, University Health Network

Sudipta Saha    -  Contact Me
Peter Munk Cardiac Centre, University Health Network

*David Barron    -  Contact Me
Hospital for Sick Children

Erwin Oechslin Oechslin    -  Contact Me
Toronto General Hospital

Lee Benson    -  Contact Me
Hospital for Sick Children

Rachel Vanderlaan    -  Contact Me
Hospital for Sick Children

Shouka Parvin Nejad    -  Contact Me
N/A

Objective: The burden of reintervention (surgical and catheter-based) is high for patients with Tetralogy of Fallot (TOF). We report the impact of type of index surgery on late outcomes in our TOF cohort over a 30-year period.

Methods: Patients with index TOF repair with follow up at our adult center between 1990 and 2022 were included in our study (n=1,239). TOF with absent pulmonary valve and TOF with pulmonary atresia with or without major aortopulmonary collaterals were excluded. Descriptive statistics and survival analysis were performed, with comparison of reinterventions made between patients receiving a transannular patch (TAP, n= 551) or a pulmonary valve sparing repair (VSR, n=647) using cumulative incidence frequencies.

Results: Sixty percent of patient were male (736/1239) with 71% (878/1239) of the cohort under the age of 18. A staged repair was performed in 14% (178/1239), with 62% undergoing a TAP repair. Overall survival of the cohort was 97% at 15 years and 96% % at 25 years. Analysis of index surgical repair approach showed similar overall survival at 25 years between TAP and VSR (p=0.26), while need for major reinterventions at 25 years was overall higher in the TAP cohort (62% TAP vs 31% VSR, p<0.001), with 22.8% undergoing 2 reinterventions and 12% undergoing >2 reinterventions. Isolated placement of pulmonary artery stents was higher in TAP cohort at 15 years (10% TAP vs 4% VSR) and 25 years (19% TAP vs 10% VSR) post index repair (p<0.001). Children who had a VSR repair had higher incidence of RVOT reoperation within the first 10 years post index repair compared to the TAP repair (6.1% vs 3.3 %; p=0.047). At the time of discharge after index repair, 25% (159/647) of children with VSR repair had ≥ moderate pulmonary regurgitation. In the overall cohort, 15.8% had replacement of their pulmonary valve (PVR) at 15 years, while 43% had a PVR by 25 years follow up. PVR was higher after TAP repair at 25 years following the index operation (53% TAP vs 26% VSR, p< 0.001, Figure 1).

Conclusion: The burden of reintervention remains high in TOF population. The index surgical repair approach did not impact overall survival but resulted in higher need for reintervention for those receiving a TAP repair. Echocardiography and MRI imaging data will be integrated into propensity matching studies and risk factor analysis to understand patient characteristics contributing to reintervention burden over the lifespan.

Pulmonary valve intervention