Association of tetralogy of Fallot and complete atrioventricular canal: a single-centre 40-year experience

Abstract

OBJECTIVES Outcome data in tetralogy of Fallot (ToF) and complete atrioventricular canal (CAVC) are limited. We report our experience for over 40 years in this patient population. METHODS Single center, retrospective analysis of patients who underwent surgical repair with diagnosis of ToF-CAVC from 1979 to 2022, divided in two different periods and compared. RESULTS A total of 116 patients were included: 1979–2007 (n = 61) and 2008–2021 (n = 55). Balanced CAVC (80%) and Rastelli type C CAVC (81%) were most common. Patients in the later era were younger (4 vs 14 months, p < 0.001), fewer had trisomy 21 (60% vs 80%, p = 0.019) and fewer had prior palliative prior procedures (31% vs 43%, p < 0.001). In the earlier era, single-patch technique was more common (62% vs 16%, p < 0.001) and in recent era double-patch technique was more common (84% vs 33%, p < 0.001). In the earlier era right ventricular outflow tract was most commonly reconstructed with transannular patch (51%) while in more recent era valve-sparing repairs were more common (69%) (p < 0.001). In-hospital mortality was 4.3%. Median follow-up was 217 and 74 months for the first and second eras. Survival for earlier and later eras at 2-, 5- and 10-years follow-up was (85.1%, 81.5%, 79.6% vs 94.2%, 94.2%, 94.2% respectively, log-rank test p = 0.03). CONCLUSIONS The surgical approach to ToF-CAVC has evolved over time. More recently, patients tended to receive primary repair at younger ages and had fewer palliative procedures. Improved surgical techniques allowing for earlier and complete repair has shown a decrease in mortality, more valve sparing procedures without an increase in total re-operations.