Perioperative management and early outcomes of surgical treatment for adult patients with tetralogy of Fallot_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LI Xi ¹ , ZHAO Ling ² , TAN Jin ¹ , YU Tao ¹ , HUANG Keli ¹ ,  JIANG Lu ¹

1. Department of Cardiovascular Surgery, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, 610072, P. R. China;
2. Department of Cardiology, 363 Hospital, Chengdu, 610097, P. R. China;

Corresponding?author：

JIANG Lu, Email: jlz213@163.com

Keywords：

Tetralogy of Fallot; adult; perioperative management; early outcomes; complications

DOI：

10.7507/1007-4848.202607020

Video：

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Objective To analyze the perioperative management strategies and early postoperative outcomes of adult patients with tetralogy of Fallot (TOF) undergoing corrective surgery. Methods A retrospective analysis was conducted on adult patients who underwent corrective surgery for TOF in Sichuan Provincial People's Hospital between June 2016 and May 2026. Demographic characteristics, concomitant intracardiac anomalies, pulmonary valve management strategies, cardiopulmonary bypass (CPB) and aortic cross-clamp (ACC) times, intensive care unit (ICU) stay, mechanical ventilation duration, postoperative right-sided pressure parameters, perioperative complications, and in-hospital outcomes were collected and analyzed. Results A total of 30 patients were enrolled, including 17 (56.7%) males and 13 (43.3%) females , with a mean age of (31.19.7) years. Preoperatively, the proportions of patients with New York Heart Association (NYHA) functional classⅠ, Ⅱ, Ⅲ, and Ⅳ were 6.7%, 46.7%, 36.7%, and 10.0%, respectively. The majority of patients presented with hypoxemia and compensatory polycythemia. Intraoperatively, 19 patients (63.3%) underwent pulmonary valve replacement (PVR), and 11 (36.7%) received pulmonary valvuloplasty. The median CPB time was 143.5 (132.5, 159.8) min, and the mean ACC time was (100.0±8.8) min. Postoperatively, the right ventricular systolic pressure was (41.03.8) mm Hg, the ratio of right ventricular to systemic systolic pressure was (37.9%±3.3%), and the right ventricular-pulmonary artery (RV-PA) systolic pressure gradient was 14.0 (12.0, 17.0) mm Hg. Postoperative arrhythmia occurred in 9 patients (30.0%). One patient (3.3%) died perioperatively due to multiple organ dysfunction syndrome secondary to severe pulmonary infection, yielding an in-hospital survival rate of 96.7%. Conclusion Adult TOF patients present with complex pathophysiologic features and require surgical and perioperative management distinct from those for pediatric patients. Appropriate pulmonary valve management and effective control of postoperative right heart pressure load contribute to favorable early outcomes. Nevertheless, vigilant surveillance for complications and sustained long-term follow-up remain essential.

1.	Iacobelli R, Tifi P, Perri G, et al. Evaluation of residual right ventricular outflow tract obstruction after pulmonary valve-sparing repair of tetralogy of Fallot: an echocardiographic study[J]. World J Pediatr Congenit Heart Surg, 2025, 16(6): 790-800.
2.	Geva T, Wald RM, Bucholz E, et al. Long-term management of right ventricular outflow tract dysfunction in repaired tetralogy of Fallot: a scientific statement from the American Heart Association[J/OL]. Circulation, 2024, 150(25): e689-e707. DOI: 10.1161/cir.0000000000001291.
3.	Wald RM, Tomlinson G, Caldarone CA, et al. Outcome prediction after tetralogy of Fallot repair: a prospective clinical and cardiovascular magnetic resonance study[J/OL]. J Am Heart Assoc, 2025, 14(8): e039006. DOI: 10.1161/JAHA.124.039006.
4.	Talwar S, George N, Bhende VV, et al. Late presenting tetralogy of Fallot-surgical management[J/OL]. Indian J Thorac Cardiovasc Surg, 2025, 41(6): 730-744. DOI: 10.1007/s12055-025-01949-0.
5.	劉明波, 何新葉, 楊曉紅, 等. 《中國心血管健康與疾病報告2024》要點解讀[J]. 中國心血管病研究, 2025, 28(32): 3989-4008.Liu MB, He XY, Yang XH, et al. Key points interpretation of China cardiovascular health and disease report 2024[J]. Chin J Cardiovasc Res, 2025, 28(32): 3989-4008.
6.	Zhou S, Yang Y, Wang L, et al. Study on the trend of congenital heart disease inpatient costs and its influencing factors in economically underdeveloped areas of China, 2015-2020: a case study of Gansu Province[J/OL]. Front Public Health, 2024, 12: 1303515. DOI: 10.3389/fpubh.2024.1303515.
7.	Fan Q, Wang Y, An Q, et al. Right ventricular dysfunction following tetralogy of Fallot correction: anatomical determinants and therapeutic strategies[J/OL]. Int J Surg, 2025, 111(6): 3979-3988. DOI: 10.1097/JS9.0000000000002367.
8.	Aichi C, Itatani K, Nakai Y, et al. Perioperative management and outcomes of surgical pulmonary valve replacement following tetralogy of Fallot repair: a retrospective study[J/OL]. Int J Surg Case Rep, 2025, 131: 111406. DOI: 10.1016/j.ijscr.2025.111406.
9.	Massarella D, McCrindle BW, Runeckles K, et al. Adherence to clinical practice guidelines for pulmonary valve intervention after tetralogy of Fallot repair: a nationwide cohort study[J]. JTCVS Open, 2024, 17: 215-228.
10.	Liu H, Liu S, Zaki A, et al. Pulmonary valve replacement in primary repair of tetralogy of Fallot in adult patients[J]. J Thorac Dis, 2020, 12(9): 4833-4841.
11.	Balzer D. Pulmonary valve replacement for tetralogy of Fallot[J]. Methodist Debakey Cardiovasc J, 2019, 15(2): 122-132.
12.	He F, Feng Z, Yuan J, et al. Pulmonary valve replacement in repaired tetralogy of Fallot: midterm impact on biventricular response and adverse clinical outcomes[J/OL]. Front Pediatr, 2022, 10: 864455. DOI: 10.3389/fped.2022.864455.
13.	Stout KK, Daniels CJ, Aboulhosn JA, et al. 2018 AHA/ACC guideline for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines[J/OL]. Circulation, 2019, 139(14): e698-e800. DOI: 10.1161/cir.0000000000000683.
14.	Upadhyay V, Nayak P, Patel R, et al. Study of right ventricular outflow tract gradient in immediate postoperative period following intracardiac repair for tetralogy of Fallot[J]. J Card Surg, 2023, 11: 57-62.
15.	Meca Aguirrezabalaga JA, Silva Guisasola J, Díaz Méndez R, et al. Pulmonary regurgitation after repaired tetralogy of Fallot: surgical versus percutaneous treatment[J]. Ann Thorac Surg, 2020, 8(15): 967.
16.	Bhushan R, Chugh V, Loona M, et al. Intracardiac repair in late adolescent and adult tetralogy of Fallot: early and midterm results from a tertiary care centre[J]. Braz J Cardiovasc Surg, 2022, 37(4): 511-516.
17.	Dezorzi C, Marenco A, Valente AM. Tricuspid regurgitation in patients with tetralogy of Fallot[J]. J Clin Med, 2023, 12(7): 2514.
18.	李希, 譚今, 黃克力, 等. 保留瓣膜的主動脈根部置換術治療法洛四聯癥術后主動脈根部擴張的臨床療效[J]. 中國胸心血管外科臨床雜志, 2024, 31(1): 122-126.Li X, Tan J, Huang KL, et al. Clinical efficacy of valve-sparing aortic root replacement for aortic root dilation after tetralogy of Fallot repair[J]. Chin J Clin Thorac Cardiovasc Surg, 2024, 31(1): 122-126.
19.	Ramaprabhu K, Idhrees M, Velayudhan B. Aortopathy in tetralogy of Fallot: a collective review[J]. Indian J Thorac Cardiovasc Surg, 2019, 35(4): 575-578.
20.	Ozkok S, Tosun O, Yucel IK, et al. Cardiac MRI in surgically repaired tetralogy of Fallot: our initial experience[J]. North Clin Istanb, 2022, 9(6): 622-631.

1. Iacobelli R, Tifi P, Perri G, et al. Evaluation of residual right ventricular outflow tract obstruction after pulmonary valve-sparing repair of tetralogy of Fallot: an echocardiographic study[J]. World J Pediatr Congenit Heart Surg, 2025, 16(6): 790-800.
2. Geva T, Wald RM, Bucholz E, et al. Long-term management of right ventricular outflow tract dysfunction in repaired tetralogy of Fallot: a scientific statement from the American Heart Association[J/OL]. Circulation, 2024, 150(25): e689-e707. DOI: 10.1161/cir.0000000000001291.
3. Wald RM, Tomlinson G, Caldarone CA, et al. Outcome prediction after tetralogy of Fallot repair: a prospective clinical and cardiovascular magnetic resonance study[J/OL]. J Am Heart Assoc, 2025, 14(8): e039006. DOI: 10.1161/JAHA.124.039006.
4. Talwar S, George N, Bhende VV, et al. Late presenting tetralogy of Fallot-surgical management[J/OL]. Indian J Thorac Cardiovasc Surg, 2025, 41(6): 730-744. DOI: 10.1007/s12055-025-01949-0.
5. 劉明波, 何新葉, 楊曉紅, 等. 《中國心血管健康與疾病報告2024》要點解讀[J]. 中國心血管病研究, 2025, 28(32): 3989-4008.Liu MB, He XY, Yang XH, et al. Key points interpretation of China cardiovascular health and disease report 2024[J]. Chin J Cardiovasc Res, 2025, 28(32): 3989-4008.
6. Zhou S, Yang Y, Wang L, et al. Study on the trend of congenital heart disease inpatient costs and its influencing factors in economically underdeveloped areas of China, 2015-2020: a case study of Gansu Province[J/OL]. Front Public Health, 2024, 12: 1303515. DOI: 10.3389/fpubh.2024.1303515.
7. Fan Q, Wang Y, An Q, et al. Right ventricular dysfunction following tetralogy of Fallot correction: anatomical determinants and therapeutic strategies[J/OL]. Int J Surg, 2025, 111(6): 3979-3988. DOI: 10.1097/JS9.0000000000002367.
8. Aichi C, Itatani K, Nakai Y, et al. Perioperative management and outcomes of surgical pulmonary valve replacement following tetralogy of Fallot repair: a retrospective study[J/OL]. Int J Surg Case Rep, 2025, 131: 111406. DOI: 10.1016/j.ijscr.2025.111406.
9. Massarella D, McCrindle BW, Runeckles K, et al. Adherence to clinical practice guidelines for pulmonary valve intervention after tetralogy of Fallot repair: a nationwide cohort study[J]. JTCVS Open, 2024, 17: 215-228.
10. Liu H, Liu S, Zaki A, et al. Pulmonary valve replacement in primary repair of tetralogy of Fallot in adult patients[J]. J Thorac Dis, 2020, 12(9): 4833-4841.
11. Balzer D. Pulmonary valve replacement for tetralogy of Fallot[J]. Methodist Debakey Cardiovasc J, 2019, 15(2): 122-132.
12. He F, Feng Z, Yuan J, et al. Pulmonary valve replacement in repaired tetralogy of Fallot: midterm impact on biventricular response and adverse clinical outcomes[J/OL]. Front Pediatr, 2022, 10: 864455. DOI: 10.3389/fped.2022.864455.
13. Stout KK, Daniels CJ, Aboulhosn JA, et al. 2018 AHA/ACC guideline for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines[J/OL]. Circulation, 2019, 139(14): e698-e800. DOI: 10.1161/cir.0000000000000683.
14. Upadhyay V, Nayak P, Patel R, et al. Study of right ventricular outflow tract gradient in immediate postoperative period following intracardiac repair for tetralogy of Fallot[J]. J Card Surg, 2023, 11: 57-62.
15. Meca Aguirrezabalaga JA, Silva Guisasola J, Díaz Méndez R, et al. Pulmonary regurgitation after repaired tetralogy of Fallot: surgical versus percutaneous treatment[J]. Ann Thorac Surg, 2020, 8(15): 967.
16. Bhushan R, Chugh V, Loona M, et al. Intracardiac repair in late adolescent and adult tetralogy of Fallot: early and midterm results from a tertiary care centre[J]. Braz J Cardiovasc Surg, 2022, 37(4): 511-516.
17. Dezorzi C, Marenco A, Valente AM. Tricuspid regurgitation in patients with tetralogy of Fallot[J]. J Clin Med, 2023, 12(7): 2514.
18. 李希, 譚今, 黃克力, 等. 保留瓣膜的主動脈根部置換術治療法洛四聯癥術后主動脈根部擴張的臨床療效[J]. 中國胸心血管外科臨床雜志, 2024, 31(1): 122-126.Li X, Tan J, Huang KL, et al. Clinical efficacy of valve-sparing aortic root replacement for aortic root dilation after tetralogy of Fallot repair[J]. Chin J Clin Thorac Cardiovasc Surg, 2024, 31(1): 122-126.
19. Ramaprabhu K, Idhrees M, Velayudhan B. Aortopathy in tetralogy of Fallot: a collective review[J]. Indian J Thorac Cardiovasc Surg, 2019, 35(4): 575-578.
20. Ozkok S, Tosun O, Yucel IK, et al. Cardiac MRI in surgically repaired tetralogy of Fallot: our initial experience[J]. North Clin Istanb, 2022, 9(6): 622-631.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

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