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

There is a high burden of reintervention after repair of Tetralogy of Fallot (TOF). We compare procedural burden and late outcomes in valve sparing repair (VSR) and transannular patch (TAP) cohorts over 30 years. Patients undergoing TOF repair (1990-2021, excluding complex TOF) were included in this study (n=1239) with subsequent comparisons between TAP (n=550) and VSR (n=648) cohorts. Descriptive statistics, cumulative incidence frequencies, survival analysis and propensity matching (n=425) were used to analyze reintervention burden and survival. Overall survival of the cohort was 96.7% at 15 years and 95.6% at 25 years, with similar survival between TAP and VSR cohorts (p=0.22). TAP cohort had increased incidence of procedural burden at 25 years (TAP 69.8% versus VSR 37.2%, p<0.001), with 34.6% undergoing ≥2 reinterventions. TAP cohort had higher incidence of surgical PV replacement at 15 years (TAP 20.7% versus VSR 7.6%, p<0.001) and placement of PA stents (TAP 20.2% versus VSR 4.9%, p<0.001). By contrast, VSR had higher incidence of RVOT reoperation at 15 years (VSR 7.3% versus TAP 3.6%, p=0.047). After propensity matching there was no survival advantage between the VSR and TAP cohorts (Era 2) whereas the need for RVOT reoperation was not different between the two cohorts (p=0.060). The procedural burden remains high following TOF repair. TAP is associated with higher procedural burden in matched and non-matched cohorts. VSR has increased risk of reoperation for RVOT obstruction only in non-matched comparisons. Anatomical complexity and surgical repair strategy influence procedural burden following TOF repair.

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