April 29, 2026Journal of the American College of Cardiology
Elective primary repair of acyanotic tetralogy of Fallot in early infancy: overall outcome and impact on the pulmonary valve
Key result
Early repair of acyanotic tetralogy of Fallot yields zero mortality with ~24% requiring transannular patching.
- n=42
Why the study?
Early primary repair of acyanotic tetralogy of Fallot is traditionally deferred due to perceived increased requirement for transannular patching in small infants, and its safety and impact on pulmonary valve and RVOT growth needed evaluation.
Does early primary repair of acyanotic tetralogy of Fallot allow normal RVOT growth with low morbidity and mortality in infants?
Population
42 acyanotic infants with ToF aged 4 to 87 days
Comparison
Early complete primary repair with tailored RVOT reconstruction vs traditional deferred repair
Design
Observational cohort study
Follow-up
Median 38 months (range 12 to 64 months)
Authors
Discussion
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Implication
Complete repair of acyanotic tetralogy of Fallot in early infancy can be performed safely with low mortality and a low requirement for transannular patching, potentially allowing for normal RVOT growth.
Key Points
- To assess whether elective early primary repair of acyanotic tetralogy of Fallot can be safely performed with low rates of transannular patching while preserving subsequent right ventricular outflow tract growth.
- Retrospective cohort analysis of 42 acyanotic infants (aged 4 to 87 days, median 62 days; weight 2.6 to 6.6 kg, median 4.55 kg) who underwent complete surgical repair between July 1992 and March 1999.
- Right ventricular outflow tract reconstruction was tailored using pulmonary valvotomy (n=26), main pulmonary arterioplasty (n=22), infundibular patching (n=2), and transannular patching (n=10, 24%).
- Operative and follow-up mortality was 0% across a median follow-up duration of 38 months (range 12 to 64 months).
- Postoperative right ventricular outflow tract gradient was median 10 mm Hg (range 0 to 30 mm Hg) and remained stable at follow-up at median 12 mm Hg (range 0 to 36 mm Hg), with pulmonary annulus z-value shifting from median -1.9 to -1.2.
- Postoperative morbidity included junctional ectopic tachycardia in 7 infants (1 requiring medical therapy), with 1 reoperation for recurrent outflow obstruction and 2 balloon pulmonary arterioplasties during follow-up.
Study Design
Type
Observational (n=42)
Structured PICO
Does early primary repair of acyanotic tetralogy of Fallot allow normal RVOT growth with low morbidity and mortality in infants?
P
Population
42 acyanotic infants aged 4 to 87 days with tetralogy of Fallot undergoing complete repair, followed for a median of 38 months.
E
Exposure
Early complete primary repair of ToF with tailored right ventricular outflow tract (RVOT) reconstruction (pulmonary valvotomy, main pulmonary arterioplasty, infundibular patching, or transannular patching).
O
Outcome
Overall outcome (mortality, morbidity, requirement for transannular patching) and impact on the pulmonary valve (RVOT gradient, z-value, pulmonary insufficiency) at median 38 months follow-up.surrogate
Complete repair of acyanotic tetralogy of Fallot in early infancy can be performed safely with low mortality and a low requirement for transannular patching, potentially allowing for normal RVOT growth.
Limitations
- Results regarding normal RVOT growth were not statistically significant
Cite This Study
Parry et al. (2000) conducted an observational in Acyanotic tetralogy of Fallot (n=42). Complete repair of tetralogy of Fallot in early infancy was evaluated on Requirement for transannular patching (TAP). Complete repair of acyanotic tetralogy of Fallot in early infancy resulted in no deaths and a 24% requirement for transannular patching.