Temporal changes in the surgical management of patients with tetralogy of Fallot in Denmark: a nationwide cohort study

Mathis Gröning*, Morten Holdgaard Smerup, Dorte Guldbrand Nielsen, Henrik Nissen, Kim Munk, Ulrik Markus Mortensen, Helle Andersen, Morten Engholm, Jesper Bjerre, Niels Vejlstrup, Klaus Juul, Eva Vad Søndergaard, Annette Schophuus Jensen, Troels Højsgaard Jørgensen, Hans Gustav Hørsted Thyregod, Henrik Ørbæk Andersen, Christian Jøns, Morten Helvind, Lars Sondergaard

*Corresponding author for this work

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaperJournal articleResearchpeer-review

Abstract

OBJECTIVES: To assess temporal changes in the surgical management of patients with tetralogy of Fallot including the timing of interventions, surgical techniques, reinterventions and survival in a nationwide cohort. METHODS: Patients with tetralogy of Fallot in Denmark were divided into 3 eras based on their year of birth: early (1977–1991), intermediate (1992–2006) and late (2007–2021). RESULTS: The cohort consisted of 745 patients. Median follow-up was 21.2 years (13.7–30.5). There was a temporal trend towards less shunt palliation (–0.3% per year, 95% CI –0.05 to –0.1). Median age at intracardiac repair was 2.9 years (1.8–5.0), 0.8 years (0.5–1.3) and 0.5 years (0.4–0.7) (P < 0.001) in the early, intermediate and late era, respectively. There was a temporal trend towards less valve-sparing repair (–0.7% per year, 95% CI –0.5 to –1.0) and more repair with transannular patches (0.7% per year, 95% CI 0.5–1.0). Survival at 10 years was 79% (64–76), 90% (87–93) and 95% (92–98) (P < 0.001) and pulmonary valve replacement within the first 10 years after intracardiac repair was performed in 3% (1–6), 12% (8–16) and 21% (13–29) (P < 0.001) in the early, intermediate and late era, respectively. CONCLUSIONS: There was a temporal trend towards less shunt palliation and intracardiac repair at a younger age with more use of transannular patches. While survival throughout childhood and adolescence has improved, more patients undergo pulmonary valve replacement during the first 10 years after intracardiac repair.

Original languageEnglish
Article numberezad007
JournalEuropean Journal of Cardio-Thoracic Surgery
Volume63
Issue2
Number of pages8
ISSN1010-7940
DOIs
Publication statusPublished - Feb 2023

Keywords

  • Intracardiac repair
  • Palliative shunt
  • Pulmonary valve replacement
  • Survival
  • Tetralogy of Fallot
  • Transannular patch

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