Midterm results of total correction surgery in tetralogy of Fallot

Background: We aimed to present midterm results of total correction surgery in patients with tetralogy of Fallot (TOF). Methods: A total of 104 patients with TOF (60 males, 44 females; mean age 4.1 years; range 1 to 24 years) underwent total correction between January 2006 and August 2011. Right ventricular outflow tract reconstruction was performed by transannular patching in 89 (V-Plasty technique in 10), by muscular resection from only right atriotomy in 12, and by Contegra graft in three patients. Patients were followed-up by echocardiography to detect the presence of pulmonary insufficiency, transpulmonary gradient, ventricle functions, and residual ventricular septal defect (VSD). The mean follow-up was 26.4 months (range, 6-62). Results: Early-term mortality was seen in seven patients, while no late-term mortality was observed. A permanent pacemaker was implanted to two patients with complete atrioventricular (AV) block and one patient with Mobitz type-2 AV block. Repeated echocardiography showed no residual VSD. Of 13 patients with mild pulmonary insufficiency, seven with severe pulmonary insufficiency during the follow-up period underwent off-pump injectable pulmonary valve replacement. Conclusion: Off-pump injectable pulmonary valve replacement should be considered in patients with postoperative pulmonary insufficiency.