Clinical Indications for and Outcomes of Reoperation in Adult Tetralogy of Fallot Patients in Japan: A Nationwide Retrospective Study

Background: Reoperation significantly improves outcomes in tetralogy of Fallot (TOF) patients. However, it is challenging to determine the timing for surgery, especially with complex indications, such as pulmonary regurgitation (PR) with right ventricular outflow tract stenosis or tricuspid regurgitation. Methods: This retrospective study analysed adult TOF patients who underwent reoperation at specialised centres between 2000 and 2015. Exclusions included pulmonary atresia with ventricular septal defect repaired by an extracardiac conduit, double-outlet right ventricle with subaortic ventricular septal defect and pulmonary stenosis and pulmonary atresia. Surgeons determined the primary reoperation indication. Results: Of 154 patients (59.1% male, mean age 35.2 ± 12.0 years), from 10 hospitals, eight deaths (5.2%) occurred over 5.7 years (range 2.5–8.0 years) post-reoperation. The main indications for reoperation were PR, right ventricular outflow tract stenosis, and tricuspid regurgitation (62.3%, 24.0% and 18.2%, respectively). Patients with PR showed more variability in preoperative right ventricular end-diastolic volume index values, particularly without concurrent indications. Conclusion: This study sheds light on reoperation outcomes in Japanese TOF patients before percutaneous treatment availability. Surgical decisions, especially with concurrent indications, need adaptable approaches. Despite the absence of a consensus on preoperative evaluation and thresholds for reoperation, our findings may support current surgical decision-making.