Childhood tetralogy of Fallot repair outcomes in the modern era

Tetralogy of Fallot (TOF) is a congenital cyanotic heart lesion that involves four structural components: ventricular septal defect (VSD), pulmonary stenosis, overriding aorta, and right ventricular hypertrophy. Long-term outcomes after repaired TOF (rTOF) are largely informed by historical cohorts, potentially limiting their relevance to patients treated in the modern era of advanced cardiac care. 1 The 2022 American Association for Thoracic Surgery (AATS) 2 guidelines recommend complete surgical correction between 3 and 6 months of age in asymptomatic infants. Palliative procedures are considered reasonable for high-risk infants. 2 The guidelines also endorse valve-sparing approaches, in addition to other recommendations 2 that were less standardized for TOF patients more than 40 years ago. Bitterman et al.’s article, 3 “Natural history of children after tetralogy of Fallot repair” published in a recent issue of Pediatric Research , addresses gaps in knowledge of rTOF outcomes in the current era. The authors utilize a single-center retrospective cohort study of TOF patients who were repaired between 2000 and 2015. In this commentary, 3 we evaluate the strengths and limitations of this study and identify areas for future research.