McDonald JA; Department of Paediatrics, The University of Melbourne, Australia
Ye XT; Jones B; Zannino D; Konstantinov I; Brink J; Brizard
C; d’Udekem Y

Heart, Lung & Circulation. 33(8):1209-1214, 2024 Aug.

BACKGROUND: The exercise capacity long after repair of tetralogy of
Fallot, when performed exclusively with a transatrial repair, is unclear.
It is also unknown whether echocardiography and cardiopulmonary exercise
testing can predict the risk of reoperation in this patient group.
METHOD: We retrospectively reviewed the clinical records of 59 patients
who underwent cardiopulmonary exercise testing after transatrial Fallot
repair at a single centre. Patients underwent cardiopulmonary exercise
testing at a mean age of 16.6+/-4.4 years, and at 15.3+/-4.1 years after
Fallot repair.
RESULTS: At testing, the volume of oxygen consumption at maximal exercise
(VO2 max) was 71%+/-13% and the oxygen pulse was 80%+/-17% of predicted
values. Seventeen (17) patients (29%) had a VO2 max superior to 80% of the
predicted value. Thirty-two (32) patients (56%) had severe pulmonary
regurgitation, three (5%) had moderate pulmonary regurgitation, and 12
(21%) had mild pulmonary regurgitation. After a mean of 7.8+/-3.9 years
following cardiopulmonary exercise testing (23+/-5.3 years after the
repair), 21 (40%) patients underwent reoperation. Right ventricular
dilation and systolic function on echocardiography were both significantly
associated with subsequent reoperation rates. Patients who had severe
right ventricular dilation were eight times more likely to undergo
subsequent reoperation (hazard ratio 8.67; 1.82-41.3; p=0.007). No
cardiopulmonary exercise testing variable independently predicted
reoperation.
CONCLUSIONS: The exercise capacity at adolescence following transatrial
repair of tetralogy of Fallot is maintained at around 70% of predicted
values. Only the patients with normal right ventricular size and normal
right ventricular function seemed to be protected from reoperation over
the subsequent decade. We found no exercise variables which predicted
reoperation.