Late results after correction of tetralogy of Fallot necessitating outflow tract reconstruction. Comparison with results after correction without outflow tract patch.

From 1958 to 1980, at the Department of Cardiovascular Surgery in Munich, 642 patients with Tetralogy of Fallot were corrected and survived the 30th postoperative day. In 140 ( = 21.8%) a valveless outflow tract patch was used. This technique was not needed in 502 ( = 78.2%) patients. Our cases differ from corrections performed today in that the patients were already 10 years old on an average when they underwent primary or secondary corrective surgery. Besides that, they could not benefit from modern methods of myocardial protection at that time. Twenty-five patients ( = 17.9%) with an outflow tract patch died within 25 years postoperatively. The main cause of death (in 68% of all non-survivors) was cardiac in origin. We compared the long-term survival rates of our 140 patch recipients with the rates of our non-patch group (patients without a right ventricular outflow tract patch) using the actuarial method. The difference between the 2 groups, 25 years postoperatively, proved highly significant: 80% survival in the patch group and 93.4% survival in the non-patch group. We conclude that patients with a valveless right ventricular outflow patch should be observed very carefully in a follow-up program. Increasing cardiomegaly postoperatively should be clarified.