Ylitalo Pekka, Nieminen Heta, Pitkänen Olli M, Jokinen Eero, Sairanen Heikki
Children's Hospital, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland.
Children's Hospital, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
Eur J Cardiothorac Surg. 2015 Jul;48(1):91-7. doi: 10.1093/ejcts/ezu401. Epub 2014 Oct 17.
Our study is a population-based evaluation of the long-term results after surgical repair for tetralogy of Fallot (TOF). All patients operated on in the country since the first procedure were identified via the Finnish research database of paediatric cardiac surgery and the Finnish population register. The follow-up was 99% completed due to comprehensive coverage of the registers.
The Finnish research database of paediatric cardiac surgery, surgical logs, diagnosis cards and computer files of the hospitals were used for data collection. The Finnish Population Register Center was used to obtain current patient status and dates of death and emigration.
A total of 600 patients underwent surgical repair of TOF before the age of 15 years during the 46-year period from 1962 to 2007. The mean follow-up time was 23 ± 12.1 years; 513 (85%) patients were alive and living in Finland, 82 (14%) had died and 5 patients were lost to the follow-up (0.8%). A total of 40 patients (7%) died early (≤30 days) and 42 (7%) died late (>30 days) after the surgical correction. During the last two decades the early mortality rate was 1.5% and no early deaths were observed after the year 2000. A transannular patch (TAP) was used in the reconstruction of the right ventricular outflow tract in 191 (32%) of these patients and had no influence on late mortality but the event-free survival was significantly inferior in these patients. If a primary palliation was performed before the correction, the late survival was significantly inferior when compared with patients without initial palliation. Also reoperation was more common in patients with primary palliation.
The long-term prognosis of surgically corrected TOF patients is good and has improved with each decade since the beginning of TOF surgery in Finland. Primary repair of tetralogy of Fallot predicts a lower mortality rate and longer freedom from reoperation when compared with two-stage repair. Need of a TAP in TOF surgery carries a higher risk of reoperation but has no impact on late survival.
我们的研究是基于人群对法洛四联症（TOF）手术修复后的长期结果进行评估。通过芬兰儿科心脏手术研究数据库和芬兰人口登记册，确定了该国自首次手术以来接受手术的所有患者。由于登记册的全面覆盖，随访完成率达99%。
利用芬兰儿科心脏手术研究数据库、手术记录、诊断卡和医院的计算机文件进行数据收集。芬兰人口登记中心用于获取患者当前状态、死亡日期和移民日期。
在1962年至2007年的46年期间，共有600例患者在15岁之前接受了TOF手术修复。平均随访时间为23±12.1年；513例（85%）患者存活且居住在芬兰，82例（14%）患者死亡，5例患者失访（0.8%）。共有40例（7%）患者在手术矫正后早期（≤30天）死亡，42例（7%）患者在手术矫正后晚期（>30天）死亡。在过去二十年中，早期死亡率为1.5%，2000年后未观察到早期死亡。其中191例（32%）患者在右心室流出道重建中使用了跨环补片（TAP），这对晚期死亡率没有影响，但这些患者的无事件生存率明显较低。如果在矫正前进行了一期姑息手术，与未进行初始姑息手术的患者相比，晚期生存率明显较低。而且一期姑息手术的患者再次手术更为常见。
自芬兰开展TOF手术以来，每十年TOF手术矫正患者的长期预后都有所改善，目前预后良好。与两阶段修复相比，法洛四联症的一期修复预测死亡率更低，再次手术的间隔时间更长。TOF手术中使用TAP会增加再次手术的风险，但对晚期生存没有影响。
