ISSN : 1301-5680
e-ISSN : 2149-8156
Turkish Journal of Thoracic and Cardiovascular Surgery     
Reoperations After Total Correction of Tetralogy of Fallot
Hasan Basri Erdoğan, Vedat Erentuğ, Nihan Kayalar, Nilgün Bozbuğa, Kaan Kırali, Gökhan İpek, Esat Akıncı, Cevat Yakut
Department of Cardiovascular Surgery, Koşuyolu Heart and Research Hospital, İstanbul
Background: Although the immediate results of definitive repair for tetralogy of Fallot (TOF) are excellent, it is known that some patients require a second or even third operation. The aim of this study was to analyze the indications, surgical procedures, and clinical outcomes of patients undergoing reoperation.

Methods: Between 1985 and 2003, 211 patients underwent corrective repair for TOF in our clinic. Of these, 12 patients (%5.6; 7 females, 5 males; mean age 14.4±5.6 years; range 6 to 25 years) required reoperation. In all the patients, indication for reoperation was residual ventricular septal defect (VSD). Additionally, five patients had severe right ventricular outflow tract (RVOT) obstruction, and one patient had severe pulmonary regurgitation. At the reoperation, a new patch was placed to close the residual VSD in seven patients, and the former patch was repaired with pledgeted sutures in the remaining five. A pulmonary xenograft was implanted in the patient with severe pulmonary valve insufficiency. The mean follow-up after reoperation was 48.4±9 months.

Results: There was no operative mortality. The only perioperative complication was injury to the right ventricle during sternotomy in one patient. One patient underwent a third operation for recurrent VSD due to infective endocarditis. Functional status was NYHA class I in eight patients, and class II in three patients. On final evaluations, there was no residual VSD or pulmonary regurgitation. The only mortality occurred due to a massive cerebral hemorrhage in the patient who underwent a third operation.

Conclusion: For patients presenting with residual VSD or RVOT problems after correction of TOF, a reoperation should be considered in case progressive right ventricular failure and clinical deterioration develop. Reoperations are effective in relief of residual VSDs and RVOT pathologies and offer good mid-term results.

Keywords : Aortic valve insufficiency; heart septal defects, ventricular/ surgery; postoperative complications; pulmonary valve insufficiency/etiology; reoperation; tetralogy of Fallot/surgery; ventricular outflow obstruction/surgery
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