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Am J Cardiol. 2014 Sep 15;114(6):901-8. doi: 10.1016/j.amjcard.2014.06.023. Epub 2014 Jul 2.

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

Author information

1
Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota; Departament de Pediatria, Universitat Autònoma de Barcelona, Barcelona, Spain.
2
Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota.
3
Division of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota.
4
Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota.
5
Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.
6
Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota. Electronic address: burkhart.harold@gmail.com.

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.

PMID:
25087464
DOI:
10.1016/j.amjcard.2014.06.023
[Indexed for MEDLINE]

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