Table 4.

Outcome for late tetralogy of Fallot

Sr no	Author and year of study	Patient population and age at operation (years)	Type of intervention	Early outcomes	Median follow-up	Outcome
01	Khajali Z et al., 2023 [30]	94 adult patients undergoing TOF repair (mean age: 26.7 years)	Total correction; some with prior shunt palliation	In-hospital mortality of 5.3%; significant reduction in tricuspid regurgitation post-surgery	1 year	Tetralogy of Fallot total correction at older age deemed safe with acceptable results; age not a contraindication for TFTC
02	Bhushan R et al., 2022 [31]	45 adult patients undergoing TOF repair (median age: 21 years)	Intracardiac repair using various approaches; Jhajhria Infundibular Resection Adequacy Assessment Technique (JIRAAT)	Right bundle branch block in 14 patients; early postoperative mortality rate of 2%	Not specified	Low mortality; less residual RVOT obstruction; significant improvement in quality of life
03	Lee MG et al., 2021 [32]	293 adult survivors of TOF repair, median age at repair 2.6 years	Trans-atrial repair (51%), right ventriculotomy (34%)	Excellent adult survival (97% overall); arrhythmias in 24% (atrial in 12%, ventricular in 6%); pulmonary valve intervention in 57%	9 years (max 40 years)	Age-adjusted survival: 99% at 20 years, 95% at 40 years, 83% at 60 years. Freedom from PV intervention and arrhythmia decreased significantly by 60 years (16% and 31%, respectively). Excellent functional status in 99.5% (NYHA class I/II)
04	Yasukawa T et al., 2021 [33]	30 adults undergoing surgical PVR for chronic pulmonary regurgitation late after TOF repair (median interval: 29 years)	Pulmonary valve replacement (PVR)	LVSVI remained low; subnormal-SVI group had higher ablation therapy rate pre-PVR; unchanged LVSVI post-PVR	1 year post-PVR (76.7% re-evaluated)	LVSVI did not fully recover after PVR; patients in subnormal-SVI group had elevated BNP levels post-PVR and no difference in clinical event incidence between groups
05	Ducas R A et al., 2021 [34]	230 adults (born 1981–1996) undergoing childhood ToF repair; median follow-up age: 25 years	Annulus-preserving (AP) vs transannular patch (TAP) repair	Reintervention more common in TAP group (72.2% TAP vs 20.2% AP, OR 5.5, P < 0.001); PVR significantly higher in the TAP group	7.9 years (IQR 3.5–12)	Significantly fewer late reinterventions in the AP group; the TAP group had higher PVR needs
06	Egbe AC et al., 2019 [29]	18,353 adult TOF patients with 1230 PVRs performed; median age at PVR: 34 years	Pulmonary valve replacement (PVR) with transcatheter PVR in 7.3%	Temporal increase in admissions for PVR (3.7% early era to 9.6% late era); in-hospital mortality decreased (4.1% early era to 0.8% late era)	Not specified	Proportion of PVR admissions increased; younger age at PVR and decreased in-hospital mortality over time; knowledge gaps about cumulative lifetime risks remain
07	Dłużniewska N et al., 2018 [35]	83 adult patients with repaired TOF (mean age: 30.5 ± 10.7 years)	Long-term follow-up of repaired TOF patients without pulmonary valve replacement	No significant differences in CPET and CMR parameters between groups (< 25 years vs ≥ 25 years post-repair)	Up to 25 years after TOF repair	Good long-term survival and clinical condition; QRS duration correlated with RV function; no significant deterioration in functional status over time
08	Waqar T et al., 2017 [25]	307 patients (mean age: 9.56 ± 4.89 years) undergoing TOF repair after infancy	Primary surgical repair; 4 patients with prior modified Blalock-Taussig shunts	Postoperative complications in 7.8%; pleural effusion (3.9%), complete heart block (0.3%); residual VSD (2.6%); moderate/severe pulmonary regurgitation (37.1%)	30 days	Low 30-day mortality (1.3%); good outcomes in children and young adults undergoing late TOF repair
09	Khan I et al., 2016 [24]	80 adult patients undergoing TOF repair (mean age: 21 ± 0.21 years)	Surgical repair; primary repair and post-palliative procedures	In-hospital mortality: 8%; postoperative complications included low cardiac output syndrome (11.25%), pleural effusion (3.75%), reoperation for bleeding (3.8%), and moderate/severe pulmonary regurgitation in 25% (transannular patch group only)	30 days	Mortality and morbidity rates comparable to international standards. Increasing experience improves outcomes
10	Luijten LW et al., 2015 [36]	453 patients with median age at operation 0.6 years; median age at last follow-up 14.3 years	Transatrial-transpulmonary repair with or without transannular patch (TAP)	Early mortality 1.1%; late mortality 2.4%; overall survival 97.3% at 10 years and 91.8% at 25 years	25 years	TP associated with poorer event-free survival (27.9% TP vs 78.5% non-TP at 25 years); PVR common at longer follow-up
11	Talwar S et al., 2014 [13]	41 adult patients undergoing TOF repair (age range: 30–52 years)	Surgical repair; aortopulmonary collaterals occluded prior to surgery in 28 patients; 24 patients underwent transatrial repair	Early mortality: 2 patients; median duration of ventilation: 12 h (6–48 h); significant correlation between low preoperative oxygen saturation and increased inotropic score, mechanical ventilation, intensive care unit, and hospital stay	42 months	Repair of TOF in and beyond the fourth decade is feasible with acceptable results. Prolonged postoperative course in patients with high hematocrit, low oxygen saturation, right ventricular dysfunction, aortopulmonary collaterals, or high RVOT gradients
12	Atik FA et al., 2004 [27]	39 adults with TOF repair (mean age 26.6 years, range 18–67)	Transatrial/transpulmonary approach (41%), TAP (15.4%)	Hospital mortality 5.1%, late mortality 7.7%; 79.4% survivors in NYHA class I	45.1 months (1–194 months)	Actuarial survival: 91.2% at 3 years, 85.5% at 7 years, 68.4% at 15 years. Late complications include arrhythmias (38.9%), RV dysfunction (38.2%), and moderate/severe PR (26.5%)
13	Nollert G et al., 1997 [14]	71 adult TOF patients undergoing repair (age ≥ 18 years); mean age: 27.7 years	Surgical correction with pulmonary stenosis repair	Operative mortality: 24%; 1-year mortality: 8%; 10-year survival: 94%; 35-year survival: 72%	35 years	Long-term survival was comparable to normal life expectancy. At follow-up, > 80% reported being in NYHA class I or II, with 95% in better condition than before surgery. Repair of TOF in adulthood shows excellent long-term outcomes
14	John S et al., 1986 [15]	200 TOF patients undergoing repair (age > 14 years)	Intracardiac repair; transannular gusset used in 74% of patients in the last 5 years	Hospital mortality: 1.3% in the last 5 years; residual VSD: 1% overall, zero in the last 12 years	17 years	97% of survivors are asymptomatic and leading active lives. Excellent or good hemodynamic results in 88% of recatheterized patients. Repair in adolescents and adults achieves excellent outcomes and easier hemodynamic correction than in children

TOF, tetralogy of Fallot; RVOT, right ventricular outflow tract; TAP, transannular patch; AP, annulus-preserving; PVR, pulmonary valve replacement; LVSVI, left ventricular stroke volume index; CPET, cardiopulmonary exercise testing; CMR, cardiac magnetic resonance; RV, right ventricle; NYHA, New York Heart Association; PR, pulmonary regurgitation; VSD, ventricular septal defect; OR, odds ratio; IQR, interquartile range