{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T15:46:44Z","timestamp":1787500004395,"version":"build-2736575974"},"reference-count":13,"publisher":"BMJ","issue":"22","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Heart"],"published-print":{"date-parts":[[2018,11]]},"abstract":"\n Objectives<\/jats:title>\n Treatment of infants with tetralogy of Fallot (ToF) has evolved in the last two decades with increasing use of primary surgical repair (PrR) and transcatheter right ventricular outflow tract palliation (RVOTd), and fewer systemic-to-pulmonary shunts (SPS). We aim to report contemporary results using these treatment options in a comparative study.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n This a retrospective study using data from the UK National Congenital Heart Disease Audit. All infants (n=1662, median age 181 days) with ToF and no other complex defects undergoing repair or palliation between 2000 and 2013 were considered. Matching algorithms were used to minimise confounding due to lower age and weight in those palliated.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Patients underwent PrR (n=1244), SPS (n=311) or RVOTd (n=107). Mortality at 12 years was higher when repair or palliation was performed before the age of 60 days rather than after, most significantly for primary repair (18.7% vs 2.2%, P<0.001), less so for RVOTd (10.8% vs 0%, P=0.06) or SPS (12.4% vs 8.3%, P=0.2). In the matched groups of patients, RVOTd was associated with more right ventricular outflow tract (RVOT) reinterventions (HR=2.3, P=0.05\u2009vs PrR, HR=7.2, P=0.001\u2009vs SPS) and fewer pulmonary valve replacements (PVR) (HR=0.3\u2009vs PrR, P=0.05) at 12 years, with lower mortality after complete repair (HR=0.2\u2009versus PrR, P=0.09).<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n We found that RVOTd was associated with more RVOT reinterventions, fewer PVR and fewer deaths when compared with PrR in comparable, young infants, especially so in those under 60 days at the time of the first procedure.<\/jats:p>\n <\/jats:sec>","DOI":"10.1136\/heartjnl-2018-312958","type":"journal-article","created":{"date-parts":[[2018,5,2]],"date-time":"2018-05-02T12:31:20Z","timestamp":1525264280000},"page":"1864-1870","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":28,"title":["Primary repair versus surgical and transcatheter palliation in infants with tetralogy of Fallot"],"prefix":"10.1136","volume":"104","author":[{"given":"Dan M","family":"Dorobantu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alireza S","family":"Mahani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mansour T A","family":"Sharabiani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ragini","family":"Pandey","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianni D","family":"Angelini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew J","family":"Parry","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3180-6993","authenticated-orcid":false,"given":"Robert M R","family":"Tulloh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robin P","family":"Martin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Serban C","family":"Stoica","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2018,5,2]]},"reference":[{"key":"2020050721422834000_104.22.1864.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2011.02.030"},{"key":"2020050721422834000_104.22.1864.2","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1053\/j.semtcvs.2015.08.006","article-title":"Tetralogy of fallot","volume":"27","author":"Fraser","year":"2015","journal-title":"Semin Thorac Cardiovasc Surg"},{"key":"2020050721422834000_104.22.1864.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2009.12.060"},{"key":"2020050721422834000_104.22.1864.4","doi-asserted-by":"crossref","first-page":"845","DOI":"10.1016\/j.athoracsur.2016.07.020","article-title":"Optimal timing for elective early primary repair of tetralogy of fallot: analysis of intermediate term outcomes","volume":"103","author":"Cunningham","year":"2017","journal-title":"Ann Thorac Surg"},{"key":"2020050721422834000_104.22.1864.5","doi-asserted-by":"crossref","first-page":"1692","DOI":"10.1016\/j.jtcvs.2017.05.042","article-title":"Young infants with severe tetralogy of Fallot: Early primary surgery versus transcatheter palliation","volume":"154","author":"Wilder","year":"2017","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2020050721422834000_104.22.1864.6","doi-asserted-by":"publisher","DOI":"10.1093\/ejcts\/ezv435"},{"key":"2020050721422834000_104.22.1864.7","unstructured":"Sharabiani MT , Mahani AS . 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