Evaluation of medium –term outcomes and factors affecting the reoperation in patients with fallot tetralogy who underwent total correction surgery

Evaluation of Medium –Term Outcomes and Factors affecting the reoperation in patients with Fallot tetralogy who underwent total correction surgery Objectives : To make research on clinical and laboratory findings of the patients who is operated due to fallot tetralogy and identify mid phase prognosis; for the sub group in case of reoperation the factors which effect the operation decision. Materials and Methods : The patients who were operated with the diagnosis of Fallot Tetralogy in Dokuz Eylul University Faculty of Medicine Department of Cardiothoracic Surgery between January 1992 and November 2014 are monitored retrospectively. The patients who has at least one policlinical control and at least one policlinical control and echocardiography are included in the research. The clinical and laboratory findings (EKG, EKO, MRI, angiography) of the patients who are included in the research retrospectively are provided from the patients' files. The preoperative and postoperative findings are compared. Findings: 190 patients are operated between January 1992-November 2014. 84 of them are included in the research. Patients' average age is 15,6±7,8, average age of diagnosis is 3,5±1,5. Follow up period after operation is 6,4±5,06 years. McGoon rate is detected as <1,2 for 12 patients, between 1,2-1,8 for 8 patients, >1,8 for 64 patients. It is also detected that MBT shunt operation is made on 12 patient whose McGoon rate is <1,2. During the follow up, mortality is not seen in our patients. Reoperation is required in 24 patients(28%). The factors that effect the reoperation, 10 patients (%11,9) residue VSD, 1 patient (%1,2) RVOT revision, 1 patient (1,2%) residue VSD and RVOT revision, 7 patients (%8,3) pulmonic regurgitation, 1 patient (1,2) pulmonic regurgitation and RVOT revision, 2 patients (2,4 %) pulmonic and tricuspid regurgitation, 1 patient (1,2%) tricuspid regurgitation and residue VSD and are reoperated. Cardiac MR findings and PVR are applied on six patients of ten patients on who PVR is applied. When the average of the values are considered, pulmonic regurgitation's regurgiation fraction is 57,17±30,7 ml/m2; it is identified that right ventricle and systolic volume is 91± 23,55 ml/m2; right ventricle EF %40 ±5,0; right ventricle and diastolic volume is 149,5±48 ml/m2. Whereas factors which effect pulmonary valve replacement are examined, RVOT aneurysm, tricuspid regurgiation, systolic movement of tricuspid in annular plan (TAPSE) <16, that there is no risk factor on gender; only heavy pulmanic regurgitation has significant risk factor is detected (p=0,01). Heavy pulmanic regurgitation increase the risk 18 times more, the fact that TAPSE<16 increase the risk 16 times more however significance is not identified(p=0,065). Average QRS period was 138,67±24,38 milisecond(msec.). After the operation QRS period, it is detected that the QRS period is significantly high (p<0,01). Flatter is detected in four of the patients, two patients are applied electrophysiologic study. A complete AV block for one patient and due to ventricular tachycardia intracardiac defibrillator (ICD) are implanted. Result : Following the complete correction, no mortality is detected in our policlinical monitoring. The factors which effect reoperation are residue VSD, pulmonic regurgitation, tricuspid regurgiation, RVOT aneurysm. For a settled consensus controversial point, long term follow up periods are required. Keywords: fallot tetralogy, monitoring after surgery, reoperation