A multicenter analysis of the choice of initial surgical procedure in tetralogy of Fallot

A current debate on the surgical management of patients with tetralogy of Fallot (TOF) focuses largely on primary repair vs initial shunt in younger and/or smaller patients. To characterize practice patterns throughout the United States with respect to the choice of initial surgical procedure in patients with TOF, we analyzed data from a multicenter database. This retrospective study focused on 938 patients from 12 institutions who underwent their initial operation during the 10-year period 1986 through 1995. Overall, the percentage of shunts decreased from 35.1% (1986-1990) to 22.0% (1991-1995) (p < 0.0001). The percentage of primary repairs increased accordingly. However, there was marked interinstitutional variability. For the group of patients aged 3 months or less the overall in-hospital mortality was significantly higher than that for older patients for both shunts and repairs. Multiple logistic regression analysis indicated that age, weight, date of surgery, and the interactions between date of surgery and institutional volume and between age and institutional volume were significant predictors of the initial surgical management of TOF. With this model only part of the observed variance could be explained. Other unidentified variables, including "institutional preference," may be significant factors influencing the choice of initial surgical procedure.