Analysis of early surgical outcomes in adolescent and adult patients undergoing repair for tetralogy of Fallot

BACKGROUND: Tetralogy of Fallot is the most common cyanotic CHD and is ideally repaired during infancy. However, delayed diagnosis and limited access to congenital cardiac care may result in presentation during adolescence or adulthood. This study evaluated outcomes of tetralogy of Fallot repair in patients aged ≥ 13 years. PATIENTS AND METHODS: This retrospective cohort study included patients aged ≥ 13 years undergoing primary tetralogy of Fallot repair between June 2016 and June 2025. Demographic, operative, and post-operative data, including early mortality and reintervention, were analysed. RESULTS: Ninety-four patients underwent repair at a median age of 15 years (interquartile range: 3) and weight of 36.5 kg (interquartile range: 12.2). Pre-operative coil embolisation of aortopulmonary collaterals was required in 26.6%. Mean cardiopulmonary bypass and aortic cross-clamp times were 114.8 ± 49.8 and 82.4 ± 35.6 minutes, respectively. Mean ventilation duration was 7.7 ± 7.1 hours, ICU stay 3.9 ± 1.0 days, and post-operative hospital stay 4.6 ± 1.3 days. Transannular patch repair was performed in 65 patients (69%), while 29 (31%) underwent pulmonary valve-preserving repair, with comparable early outcomes. Thirty-day mortality was 1.06%, and reintervention occurred in 2.1% during a mean follow-up of 38.4 months. CONCLUSIONS: Primary repair of tetralogy of Fallot in late-presenting adolescents and adults can be performed with low early mortality and acceptable morbidity. Careful pre-operative assessment, including identification and management of significant aortopulmonary collaterals, and individualised right ventricular outflow tract reconstruction are important components of management. These findings support definitive repair in appropriately selected late-presenting patients.