Kantonsspital St.Gallen

Risk Factors for Mortality and Ventricular Tachycardia in Patients With Repaired Tetralogy of Fallot: A Systematic Review and Meta-analysis

Mathias Possner, Stephanie Y Tseng, Fares Alahdab, Jouke P Bokma, Adam M Lubert, Paul Khairy, M Hassan Murad, Walid Ben Ali, Larry J Prokop, Richard J Czosek, Gruschen R Veldtman & Tarek Alsaied


Patients with repaired tetralogy of Fallot (rTOF) have increased risk for mortality, sudden cardiac death, and ventricular tachycardia (VT). The aim of this systematic review and meta-analysis is to offer an updated analysis of risk factors following significant changes in surgical and perioperative management.

A meta-analysis based on the published literature between 2008 and 2018 was conducted. Endpoints were VT, cardiac mortality/VT, and all-cause mortality/VT. Studies with ≥100 patients and ≥10 events were included.

Fifteen studies including 7218 patients (average age 27.5 years) were analyzed. Risk factors for VT included older age (per 1 year, odds ratio [OR]: 1.039; 95% confidence interval [CI]: 1.025-1.053), older age at corrective surgery (per 1 year, OR: 1.034; CI: 1.017-1.051), previous palliative shunt (OR: 3.063; CI: 1.525-6.151), number of thoracotomies (OR: 1.416; CI: 1.249-1.604), longer QRS duration (per 1 ms, OR: 1.031; CI: 1.008-1.055), and at least moderate right-ventricular dysfunction (OR: 2.160; CI_ 1.311-3.560). Additional risk factors for cardiac death/VT were previous ventriculotomy (OR: 2.269; CI: 1.226-4.198), lower left-ventricular ejection fraction (per 1%, OR: 1.049; CI: 1.029-1.071), and higher right-ventricular end diastolic volume (per 1 mL/m, OR: 1.009; CI: 1.002-1.016). Supraventricular tachycardia/atrial fibrillation was an additional risk factor for all-cause mortality/VT (OR: 1.939; CI: 1.088-3.457).

The study highlights the importance of preservation of biventricular systolic function on late outcomes. Ventricular function appears to have a greater impact on outcomes than the severity of pulmonary regurgitation alone in this patient population.
citation Possner M, Tseng S Y, Alahdab F, Bokma J P, Lubert A M, Khairy P, Murad M H, Ben Ali W, Prokop L J, Czosek R J, Veldtman G R, Alsaied T. Risk Factors for Mortality and Ventricular Tachycardia in Patients With Repaired Tetralogy of Fallot: A Systematic Review and Meta-analysis. Can J Cardiol 2020; 36:1815-1825.
type journal paper/review (English)
date of publishing 04-02-2020
journal title Can J Cardiol (36/11)
ISSN electronic 1916-7075
pages 1815-1825
PubMed 32416063
DOI 10.1016/j.cjca.2020.01.023