The Surgical Treatment of Tetralogy of Fallot

Report of the Section on Cardiovascular Surgery American College of Chest Physicians

1. This report concerns an analysis of the results obtained in the surgical treatment of 4062 cases of the tetralogy of Fallot by 39 members of the Advisory Committee of The Section on Cardiovascular Surgery of The American College of Chest Physicians.

2. Although "good" results were reported in approximately 80 per cent of the patients surviving the various standard operations, still patients submitting to these procedures are actually faced with a 39 per cent risk of death or a "poor" clinical result.

3. Complete open repair using cardiac by-pass techniques was reported by some as providing "good" results in most instances, with a total associated mortality rate approaching that of the standard incomplete techniques.

4. The operative mortality rate associated with open techniques, as reported by most surgeons, was 95 per cent. This indicates clearly that extreme caution should be exercised before any individual or group of individuals embarks upon the development and clinical employment of one of the cardiac by-pass techniques, and also indicates that the total number of these units in any geographic area should be kept as small as is practicable.

5. In view of the evidence at hand, it would seem advisable to postpone all types of surgery in patients with the tetralogy of Fallot whose general condition is not poor or deteriorating, unless a safe facility for cardiac by-pass and total correction of all the defects is available.

6. If the patient's general clinical condition is poor or deteriorating, cardiac by-pass with complete correction of the defects should be done if safe facilities are available, but if not, one of the standard incomplete operations should be performed.