Miller D C, Rossiter S J, Stinson E B, Oyer P E, Reitz B A, Shumway N E
Ann Thorac Surg. 1979 Sep;28(3):239-51. doi: 10.1016/s0003-4975(10)63113-x.
Twenty-two symptomatic patients underwent a total of 28 reoperative procedures after initial surgical repair of tetralogy of Fallot. Sixteen of the patients were considered to have unfavorable anatomy of the right ventricular outflow tract (RVOT) or pulmonary artery at the time of initial repair. Pulmonary or tricuspid valve replacement, or replacement of both valves, utilizing a xenograft bioprosthesis was performed in 1 of the 22 initial repairs, 7 of the 22 first reoperations, and 5 of the 6 second reoperations. Ultimately, 14 patients received transannular RVOT patches. The interval between the first and second reoperations for 6 patients who required 2 late reconstructive procedures was 5.8 years. No operative deaths occurred. There were 2 late deaths (1 sudden and 1 due to aspiration). Actuarial survival probability (+/- standard error of the mean) 16 years after initial repair was 72 +/- 21%. Eighteen of the 20 current survivors in the present series are completely asymptomatic without physical restrictions; the other 2 are considered to be in New York Heart Association Functional Class II. No xenograft bioprosthetic dysfunction has occurred to date, but cumulative valve follow-up is limited (13 patient-years). In selected patients, earlier pulmonary or tricuspid valve replacement or replacement of both of these valves can provide some degree of protection against recurrent deterioration.
22例有症状的患者在法洛四联症初次手术修复后共接受了28次再次手术。其中16例患者在初次修复时被认为右心室流出道（RVOT）或肺动脉解剖结构不佳。在22例初次修复手术中的1例、22例首次再次手术中的7例以及6例第二次再次手术中的5例中，使用异种移植生物假体进行了肺动脉瓣或三尖瓣置换，或双瓣置换。最终，14例患者接受了跨环RVOT补片。6例需要进行2次晚期重建手术的患者，首次和第二次再次手术之间的间隔为5.8年。无手术死亡病例。有2例晚期死亡（1例猝死，1例因误吸）。初次修复后16年的精算生存概率（±平均标准误差）为72±21%。本系列中20例目前的幸存者中有18例完全无症状，无身体限制；另外2例被认为属于纽约心脏协会心功能II级。迄今为止，尚未发生异种移植生物假体功能障碍，但瓣膜累计随访时间有限（13患者年）。对于选定的患者，早期进行肺动脉瓣或三尖瓣置换或双瓣置换可提供一定程度的保护，防止病情反复恶化。
