Latest follow-up after primary surgical correction of tetralogy of Fallot in adulthood

Background: Tetralogy of Fallot (TOF) is a prevalent congenital heart disease that requires early surgical intervention in infancy to enhance survival rates. However, some overlooked cases of TOF can persist into adulthood. Yet, they are vulnerable to serious complications from the long-standing cyanosis, which emphasizes the need for surgical correction. Nevertheless, primary surgical repair poses greater risks compared to pediatric cases due to coagulation defects, myocardial dysfunction, and previous palliative procedures. Additionally, severely dysplastic pulmonary valves often cannot be preserved, and a transannular patch can result in severe pulmonary regurgitation (PR), leading to complications such as right ventricle dysfunction and arrhythmia. Hence, in adult patients, pulmonary valve replacement (PVR) is a strong bailout option when valve preservation techniques fail to achieve satisfactory outcomes. Aim: The objective of this study is to examine information gathered from 56 adult patients with TOF who received primary repair with PVR. The study will investigate the patients' preoperative characteristics, operative details, early postoperative progress, and recent follow-up results. The study findings will enhance the current understanding of PVR outcomes and the challenges adult TOF patients face. Patients and Methods: We studied 56 patients, 16 years of age or older, who underwent primary surgical correction of TOF in adulthood using PVR from March 2013 till March 2023. We examined their preoperative characteristics, operative technical details, postoperative outcomes, and findings from their last follow-up visit. Results: The mean age is 22.16 +/- 7.06 years. Twenty-one (37.5%) patients had palliative procedures. The majority were in NYHA grade 3. The mean oxygen saturation was 76.7%, while the mean hemoglobin level was 19.18. Cyanotic spells occurred in 10.71% of patients, and palpitations in 3.57%. The mean right ventricular outflow tract (RVOT) pressure gradient (PG) was 94.55 mmHg. Twenty-eight patients had a PVR with a freestyle valve, while the other half received tissue valves or homografts. The postoperative mean RVOT PG was 14.93 mmHg. There was no significant gradient difference between the different valve types. The mean ICU stay was 3.73 days, while the mean hospital stay was 8.64 days. Pleural effusion was the most common complication occurring in seven patients. While high intercostal tube drainage requiring evacuation occurred in four patients. Only one patient required revision of his ventricular septal defect patch due to significant residual. Cerebrovascular stroke occurred in two patients and resolved completely before discharge. The cohort was followed yearly. The mean follow-up years was 3.52 years. Fifty-four patients remained in NYHA 0. The mean RVOT PG was 21.3 mmHg, without significant difference between valves. Eleven patients had grade 1 PR and one had grade 2 PR. Conclusion: TOF repair in adulthood using PVR is a safe, effective, and reproducible strategy. A longer follow-up period is mandatory to determine the degeneration rates of the biological valves used.