• Sachin Talwar, Ajay Meena, Shiv Kumar Choudhary, Anita Saxena, Shyam Sunder Kothari, Rajnish Juneja, and Balram Airan.
• Cardiothoracic Center, All India Institute of Medical Sciences, New Delhi, India.
• Congenit Heart Dis. 2014 Sep 1;9(5):424-32.

ObjectivePatients with tetralogy of Fallot (TOF) undergoing surgery in adulthood represent a challenge. We report our experience with such patients in or beyond the fourth decade of life.DesignRetrospective cohort.SettingMultispeciality tertiary level referral centerPatientsForty-one (age 30-52 years) with TOF undergoing surgery between January 2002 and March 2013. The hospital records of these patients were analyzed.InterventionsNone.Outcome MeasuresEarly and late morbidity and mortality, duration of mechanical ventilatory support, inotropic score, intensive care unit and hospital stay, and correlation with various parameters.ResultsSignificant aortopulmonary collaterals were present in 28 patients; these were occluded in cardiac catheterization laboratory prior to repair. Median intraoperative right:left ventricular pressure ratio was 0.40 (range 0.2-0.8). Median inotropic score was 10 (range 5-30). Median duration of mechanical ventilation was 12 hours (range 6-48 hours). Preoperative oxygen saturation was negatively correlated with inotropic score (P = .001, r = -0.485), mechanical ventilatory support (P = .003, r = -0.460), intensive care unit stay (P = .004, r = -0.442), and hospital stay (P = .028, r = -353). Inotropic score was higher in patients with aortopulmonary collaterals (n = 28, P = .03), high preoperative hematocrit (n = 29, P = .029), and with right ventricular dysfunction (n = 6, P = .05). Patients with right ventricular outflow tract gradient >80 mm Hg (n = 19) had prolonged hospital stay (P = .002). Patients undergoing pure transatrial repair (n = 24) showed lower inotropic score (P = .045), less intensive care unit (P = .04), and hospital stay (P = .031). There were two early and two late deaths (one from trauma and one from unknown etiology). Median follow-up was 42 months. Thirty-one patients were in New York Heart Association class II and six were in class III.ConclusionRepair of TOF in and beyond the fourth decade of life is feasible with acceptable results. Patients with high hematocrit, lower oxygen saturation, right ventricular dysfunction, aortopulmonary collaterals, and high preoperative right ventricular outflow tract gradients have a prolonged postoperative course.© 2014 Wiley Periodicals, Inc.

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