Long-term follow-up after pulmonary valve replacement in repaired tetralogy of fallot

Anna Sabate Rotes, Benjamin W. Eidem, Heidi M. Connolly, Crystal R. Bonnichsen, Jordan K. Rosedahl, Hartzell V Schaff, Joseph A. Dearani, Harold M. Burkhart

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42 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)901-908
Number of pages8
JournalAmerican Journal of Cardiology
Volume114
Issue number6
DOIs
StatePublished - 2015

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Rotes, A. S., Eidem, B. W., Connolly, H. M., Bonnichsen, C. R., Rosedahl, J. K., Schaff, H. V., Dearani, J. A., & Burkhart, H. M. (2015). Long-term follow-up after pulmonary valve replacement in repaired tetralogy of fallot. American Journal of Cardiology, 114(6), 901-908. https://doi.org/10.1016/j.amjcard.2014.06.023