RT Journal Article
SR Electronic
T1 Adults with repaired tetralogy: low mortality but high morbidity up to middle age
JF Open Heart
JO Open Heart
FD British Cardiovascular Society
SP e000564
DO 10.1136/openhrt-2016-000564
VO 4
IS 1
A1 Mark Dennis
A1 Ben Moore
A1 Irina Kotchetkova
A1 Lynne Pressley
A1 Rachael Cordina
A1 David S Celermajer
YR 2017
UL http://openheart.bmj.com/content/4/1/e000564.abstract
AB Objective Survival of patients with repaired tetralogy of Fallot (rToF) into young adulthood is very good. Concerns exist, however, over long-term morbidity and mortality as these subjects reach middle age. We aimed to assess survival and the prevalence of complications in patients with rToF seen in our Adult Congenital Heart Disease (ACHD) service.Methods One hundred and sixty-eight consecutive patients with ‘simple rToF’, aged over 16 years, followed up at our tertiary-level ACHD service in Sydney, Australia since 2000, were included. We documented mortality and analysed the prospectively defined composite end points of (a) ‘Serious adverse events’, including death, heart failure hospitalisation and/or documented ventricular arrhythmia and (b) ‘Adverse events’ inclusive of the above and endocarditis, atrial arrhythmia, defibrillator and/or pacemaker implantation.Results Mean age at the last follow-up was 34±12 years, and 55% were men. There were 10 (6%) deaths, and 26 patients (16%) experienced a ‘serious adverse event’. Fifty-one patients (30%) experienced an ‘adverse event’ and 29 patients had atrial arrhythmias. One hundred and one (61%) patients had at least one pulmonary valve replacement. By age 40 years, 93% were free of serious adverse events, and 83% were free of any adverse event. By age 50 years, only 56% had not had an adverse event. Older age and history of atrial arrhythmia were predictive of serious adverse events.Conclusion Survival into mid-adulthood in patients with rToF is very good; however, a substantial number of survivors have adverse events by the age of 50 years.