TY - JOUR
T1 - Long-term follow-up after pulmonary valve replacement in repaired tetralogy of fallot
AU - Rotes, Anna Sabate
AU - Eidem, Benjamin W.
AU - Connolly, Heidi M.
AU - Bonnichsen, Crystal R.
AU - Rosedahl, Jordan K.
AU - Schaff, Hartzell V.
AU - Dearani, Joseph A.
AU - Burkhart, Harold M.
N1 - Publisher Copyright:
© 2014 Elsevier Inc. All rights reserved.
PY - 2014/9/15
Y1 - 2014/9/15
N2 - Surgical pulmonary valve replacement (PVR) in previously repaired tetralogy of Fallot (TOF) is frequently required. There are few data in large series of patients with long-term follow-up. Our aim was to review our 40-year experience with PVR after TOF repair and to evaluate prognostic factors for reintervention and death. Between 1973 and 2012, 278 patients with repaired TOF (53% men; 31.4 - 16.4 years) underwent first PVR 24 - 13 years after TOF repair. Three or more previous operations were performed in 17% of the patients, and 42% were in New York Heart Association (NYHA) class III/IV. PVR types included porcine (n [ 211), pericardial (n [ 37), homograft (n [ 27), and mechanical (n [ 3). Early mortality was 1.4%. Mean follow-up was 7.3 - 6.8 years (maximum, 34 years). Overall survival at 5, 10, and 15 years was 93%, 83%, and 80% compared with 99%, 97%, and 95% in a gender- and age-matched US population, p <0.001. Independent risk factors for death were older age at complete repair (hazards ratio [HR] 1.2, p [ 0.012), ≥3 previous cardiac operations (HR 1.9, p [ 0.019), NYHA class III/IV at PVR (HR 2.7, p [ 0.019), and large body surface area at PVR (HR 1.9, p <0.001). Reintervention after initial PVR occurred in 25 patients. Overall 5, 10, and 15 years freedom from pulmonary valve reintervention was 97%, 85%, and 75%, respectively. Multivariate analysis demonstrated older age at PVR to be protective from reintervention (HR 0.7, p <0.001). In conclusion, PVR is a safe operation with a low rate of reintervention in repaired TOF. The total number of cardiac operations, surgical timing, and the NYHA classification before PVR are important prognostic factors.
AB - Surgical pulmonary valve replacement (PVR) in previously repaired tetralogy of Fallot (TOF) is frequently required. There are few data in large series of patients with long-term follow-up. Our aim was to review our 40-year experience with PVR after TOF repair and to evaluate prognostic factors for reintervention and death. Between 1973 and 2012, 278 patients with repaired TOF (53% men; 31.4 - 16.4 years) underwent first PVR 24 - 13 years after TOF repair. Three or more previous operations were performed in 17% of the patients, and 42% were in New York Heart Association (NYHA) class III/IV. PVR types included porcine (n [ 211), pericardial (n [ 37), homograft (n [ 27), and mechanical (n [ 3). Early mortality was 1.4%. Mean follow-up was 7.3 - 6.8 years (maximum, 34 years). Overall survival at 5, 10, and 15 years was 93%, 83%, and 80% compared with 99%, 97%, and 95% in a gender- and age-matched US population, p <0.001. Independent risk factors for death were older age at complete repair (hazards ratio [HR] 1.2, p [ 0.012), ≥3 previous cardiac operations (HR 1.9, p [ 0.019), NYHA class III/IV at PVR (HR 2.7, p [ 0.019), and large body surface area at PVR (HR 1.9, p <0.001). Reintervention after initial PVR occurred in 25 patients. Overall 5, 10, and 15 years freedom from pulmonary valve reintervention was 97%, 85%, and 75%, respectively. Multivariate analysis demonstrated older age at PVR to be protective from reintervention (HR 0.7, p <0.001). In conclusion, PVR is a safe operation with a low rate of reintervention in repaired TOF. The total number of cardiac operations, surgical timing, and the NYHA classification before PVR are important prognostic factors.
UR - http://www.scopus.com/inward/record.url?scp=84926187744&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84926187744&partnerID=8YFLogxK
U2 - 10.1016/j.amjcard.2014.06.023
DO - 10.1016/j.amjcard.2014.06.023
M3 - Article
C2 - 25087464
AN - SCOPUS:84926187744
SN - 0002-9149
VL - 114
SP - 901
EP - 908
JO - American Journal of Cardiology
JF - American Journal of Cardiology
IS - 6
ER -