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Ann Thorac Surg. 2011 Jul;92(1):161-6. doi: 10.1016/j.athoracsur.2011.02.036. Epub 2011 May 18.

Right ventricular outflow tract reconstruction with an allograft conduit in patients after tetralogy of Fallot correction: long-term follow-up.

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1
Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands. p.vandewoestijne@erasmusmc.nl

Abstract

BACKGROUND:

In tetralogy of Fallot (TOF) pulmonary regurgitation is a frequent complication after initial repair. The objective of the present study was to describe the long-term experience with the use of allograft conduits for right ventricular outflow tract (RVOT) reconstruction after correction of TOF in our institution.

METHODS:

Between 1987 and 2009, 133 allografts were implanted in 126 patients (mean age, 27.8 years). The mean time from initial TOF repair to allograft implantation was 20.8±8.8 years. Kaplan-Meier analyses were done for patient survival, freedom from allograft replacement and freedom from any cardiovascular event.

RESULTS:

Hospital mortality was 1.5% (2 patients). Mean follow-up was 8.1 years. Ten other patients died during late follow-up, in 8 patients the cause was heart failure. Patient survival was 95% at 5 years, 91% at 10 years, and 80% at 15 years. Male sex, older patient age at the time of operation, and the use of preoperative diuretics were associated with increased risk of mortality during follow-up. Freedom from allograft replacement was 83% at 10 years and 70% at 15 years. Freedom from any valve-related event was 80% at 10 years and 67% at 15 years.

CONCLUSIONS:

Right ventricular outflow tract reconstruction after previous TOF repair can be performed with low risk and a low reintervention rate. Allograft conduits function satisfactorily in the pulmonary position at longer-term follow-up. Functional status after allograft implantation in patients with a previous correction of TOF remains good. There is concern about the long-term survival and the occurrence of heart failure.

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