Routine primary repair vs two-stage repair of tetralogy of Fallot.

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Abstract
Of 194 patients, 15 (7.7%) with tetralogy of Fallot operated on under a protocol of routine primary repair despite young age died in-hospital. Most deaths were from low cardiac output. Young age and smallness of size increased the risk of operation. No deaths occurred among patients older than 4 years. High hematocrit was also a risk factor. Transannular patching has an independent effect in increasing risk. The post-repair ratio of peak pressure in the right ventricle to that in the left did not exert an independent effect. To project current risks of a 2-stage approach, it was determined that 5 of 158 patients (3.2%) died in-hospital after secondary intracardiac repair after a previous Blalock-Taussig or Waterston anastomosis. Using these data and those published on the risk of shunting, except apparently in very small babies, the risks of hospital death of a 2-stage approach are not less than those of primary repair done without a transannular patch except when body surface area is less than about 0.35 m2. When a transannular patch is used in the primary repair, the 2-stage approach is projected to be safer when the child has a body surface area of about 0.48 m2 or smaller.

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