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

ABSTRACT

BACKGROUND: 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. METHODS: 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. RESULTS: 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/m2, 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). CONCLUSIONS: 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.