LONG TERM OUTCOME OF TETRALOGY OF FALLOT AND COMPLETE ATRIOVENTRICULAR SEPTAL DEFECT REPAIR: SINGLE CENTRE EXPERIENCE

Background: We report our experience following surgical repair of Complete Atrioventricular Septal Defect (cAVSD) with Tetralogy of Fallot (TOF) over a 30 years period, focusing particularly in approach used for right ventricular outflow tract reconstruction (RVOTR). Methods: Between 1992 and 2023, 47 children with primary diagnosis of cAVSD/TOF were treated in our Institution; 39 had Down’s syndrome (81%). All except 6 had diagnosis of Rastelli’s type C. Median age and weight at surgery were 25 mos (range 4 – 224) and 12.5 Kg (range 3.5 – 83). 22 patients received initial palliation while 25 underwent direct repair. cAVSD was treated in all by double-patch technique while RVOT obstruction was relieved by transannular patch (TAP) in 21 cases (43.7%), infundibular patch in 12 (25%), and valve conduit in 11 (31,3%). Primary outcome were survival and freedom from reintervention Results: No hospital deaths occurred. Overall survival was 93.75% and 87,5% at 5 and 10 years respectively. Six patients died during follow-up, 3 after palliation before complete repair. Amongst 44 patients underwent repair, 24 (54%) need reintervention: 10 previously treated with conduit (91.6%), 6 (50%) with infundibular patch and 8 (35%) with TAP. Most common reintervention was conduit replacement (41,6%), followed by mitral valve surgery (20.8%). Conclusions: TOF with cAVSD can be repaired at low risk with favourable long-term outcome. Primary repair, when feasible, should be preferred in order to avoid inter- stage mortality. Transannular patch is a valid alternative for RVOTR because improve long-term outcome and prevents multiple conduit replacement