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detection of detrimental changes or less than expected clinical improvement of symptoms post repair leads to earlier intervention.
A study from the Royal Melbourne Hospital on long- term outcome of adult survivors of ToF was looking predominantly at patients from RCH and our study. They concluded “Excellent survival at 99%, 95%, and 83% at 20, 40, and 60 years of age, respectively, and a total of 9 (3.1%) deaths. However, a high burden of complications that appear to accelerate from the third and fourth decades of life is described. Over half of patients (57%) required at least one PV intervention and a quarter (24%) experienced an arrhythmia endpoint. Freedom from both these endpoints reduced significantly with age. The study by van den Berg21 looking at 7-15 year follow-up concluded “Mid-to-late follow-up,
symptomatic status, exercise performance, and rhythm status remain relatively normal in patients with TOF after repair according to a transatrial–transpulmonary approach. Deterioration of RV function and exercise capacity correlate with a longer interval since repair, but these moderate associations cannot be used to predict the pace of decline in the individual patient.”
Conclusion.
This study reports the outcomes of patients operated over the course of 40 years. We are operating on smaller patients and exposing them to fewer risks on bypass. Reintervention is earlier due to technological advances. It is probable that due to missing data the late reintervention results should be taken with a large grain of salt. References:
Table 1 Similar Studies
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