Published Online
on January 12, 2009

A more recent version of this article appeared on January 27, 2009

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Submitted on March 11, 2008
Accepted on October 31, 2008

Pulmonary Valve Replacement in Tetralogy of Fallot. Impact on Survival and Ventricular Tachycardia

David M. Harrild MD, PhD, Charles I. Berul MD, Frank Cecchin MD, Tal Geva MD, Kimberlee Gauvreau ScD, Frank Pigula MD, and Edward P. Walsh MD^*

From the Departments of Cardiology (D.M.H., C.I.B., F.C., T.G., K.G., E.P.W.) and Cardiac Surgery (F.P.), Children's Hospital Boston, and Departments of Pediatrics (D.M.H., C.I.B., F.C., T.G., K.G., E.P.W.) and Surgery (F.P.), Harvard Medical School, Boston, Mass.

^* To whom correspondence should be addressed. E-mail: edward.walsh{at}cardio.chboston.org.

Background—Pulmonary valve replacement (PVR) in repaired tetralogy of Fallot (TOF) reduces pulmonary regurgitation and decreases right ventricular (RV) dilation, but its long-term impact on ventricular tachycardia (VT) and mortality is unknown. This study aimed to determine the incidence of death and VT in TOF after PVR and to test the hypothesis that PVR leads to improvement in these outcomes.

Methods and Results—A total of 98 patients with TOF and late PVR for RV dilation were identified. Matched control subjects were identified for 77 of these patients; control subjects had TOF with RV dilation but no PVR. Matching was done by age (±2 years) and baseline QRS duration (±30 ms). No significant differences were found in age, QRS duration, type or decade of initial repair, age at TOF repair, or presence of pre-PVR VT between the 2 groups; limited echocardiographic and magnetic resonance imaging data showed no difference in left ventricular function but more RV dilation among PVR patients than control subjects. In the PVR group, 13 events occurred over 272 patient-years. No significant change in QRS duration was seen for any group. Overall 5- and 10-year freedom from death, VT, or both was 80% and 41%, respectively. In the matched comparison, no significant differences were seen in VT, death, or combined VT and/or death (P=0.32, P=0.06 [nearly favoring controls], and P=0.21).

Conclusions—This cohort experienced either VT or death every 20 patient-years. In a matched comparison with a similar TOF group, late PVR for symptomatic pulmonary regurgitation/RV dilation did not reduce the incidence of VT or death.

Key words: arrhythmia • pulmonary valve replacement • survival • tetralogy of Fallot

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Clinical Summaries
Circulation 2009 119: 359-361. [Extract] [Full Text]

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