Long-term outcomes following transatrial versus transventricular repair on right ventricular function in tetralogy of Fallot

Background and Aim of the Study: Outcomes after repair of tetralogy of Fallot (TOF) are goodwitheither a transventricular (TV)or transatrial (TA)approach.Wesought todetermine if there is a relationship between the TV or TA approach and right ventricular (RV) function, and the role of residual pulmonary regurgitation (PR) on the long-term outcomes. Methods: This was a retrospective cohort multicentric study on survivors after surgical repair of TOF (TA versus TV approach, ±transannular patch) between 1990 and 2004. All patients underwent magnetic resonance imaging to assessRVvolume, function, and PR. Patients were matched for length of follow-up and age. Clinical adverse events were retrieved from institutional databases. Results: Seventy-nine patients (TA/TV = 37/42,median age 0.3 and 1.0 yrs, respectively) were included.At amedian follow-up of 16.6 years (12.5-20.3), therewere no differences in freedom from reintervention (either catheter or surgical), RV volumes, function, and PR between the TA and TV groups. Pulmonary valve (PV) replacement was significantly less frequent in the TA subgroup (P = 0.033) and patients with a preserved PV showed significantly lower RV volumes and less adverse events at follow-up. Conclusions: There is no significant difference inRVvolumes and function between the TA and TV. However, the TA approach seems to be protective against PV replacement in the long-term. When PV is not preserved at repair, residual pulmonary regurgitation is a significant cause of late RV dysfunction and dilation, and is associated with a higher rate of late adverse events.