Analysis of Surgical Outcomes and Clinical Improvements Following Surgery in Tetralogy of Fallot: A Retrospective Cohort Study

Introduction: Tetralogy of Fallot (ToF), is the most common type of cyanotic Congenital Heart Disease (CHD). Even after anatomic correction and physiological correction complications such as pulmonary regurgitation leading to Right Ventricular (RV) dysfunction, recurrent obstruction of the RV outfl ow tract, arrhythmias and sudden death are found in late survivors. Aim: To analyse the clinical presentation, surgical outcomes, and clinical improvements after surgical repair of ToF. Materials and Methods: The present single-centre, retrospective cohort study was carried out, from 1st January 2005 to 31st December 2015. Case records of consecutive patients aged 18 years and above who underwent Intra cardiac repair for ToF in the Institute of Cardiovascular Diseases, The Madras Medical Mission, Chennai, Tamil Nadu, India, institute were analysed. Patient baseline characteristics, symptoms, New York Heart Association Class, and associated complications were studied. Preoperative Electrocardiogram (ECG) and Echocardiogrphy (ECHO) findings were recorded. Data was analysed by using coGuide software. Results: A total of 41 subjects (mean age 27.3±10.2 years; 56.1% male) were analysed. Cyanosis (85.4%), dyspnoea (75.6%), and clubbing (63.4%) were the most common preoperative symptoms. Preoperative New York Heart Association (NYHA) class II/III was common, with significant improvement noted at follow-up, where 43.9% of patients were asymptomatic (p<0.05). Oxygen saturation increased from 83.8% to 98.5% (p<0.001), and RVOT gradient decreased significantly (p<0.001). ECG differences were observed between preoperative, postoperative, and follow-up stages (p<0.05). Significant differences were also found between procedures like infundibular resection (alone), pulmonary valve commissurotomy (alone), trans annular patch and PR status (p<0.05). Conclusion: The results of the present study showed that long-term survival after successful surgical correction of ToF was good.