Abstract 3125: Risk Factors For Early Pulmonary Valve Replacement Following Valve Disruption In Congenital Pulmonary Stenosis And Tetralogy Of Fallot
Background: Congenital heart defects with a component of pulmonary stenosis are often palliated in childhood by disrupting the pulmonary valve, either by dilation or excision. It is unclear what factors affect a patient’s ability to tolerate long-term pulmonary insufficiency before requiring pulmonary valve replacement. We analyze potential factors that affect the interval between pulmonary valve disruption (PVD) and replacement (PVR).
Methods: Patients with congenital pulmonary stenosis or tetralogy of Fallot who had a known interval between PVD and PVR were included. Potential factors analyzed were gender, race, age at pulmonary valve disruption, presence of branch pulmonary artery stenosis, and prior shunt operation.
Results: 99 patients who underwent pulmonary valve replacement between 1994 and 2006 were analyzed. The median age at the time of surgery was 3 years for PVD (range 0 –56) and 26 years for PVR (range 1–72), resulting in a median interval of 22 years (0 – 47). Males had a significantly shorter interval than females (median 18 vs 23 years, p=0.0070). Although there was a trend for a shorter interval for African-Americans compared to Caucasians, it did not reach statistical significance (p=.1746). A significant correlation was identified between the age at the time of disruption and the subsequent interval to PVR. Overall, the PVR interval tended to increase as age at disruption increased (p=0.0014). Presence of branch pulmonary artery stenosis was associated with a significantly shorter interval to PVR (14.8 vs 23 years, p=0.0085). Placement of a shunt prior to the initial valve disruption had no effect on the interval between subsequent PVD and PVR (p=0.4977).
Conclusions: Risk factors for a shortened interval between pulmonary valve disruption and pulmonary valve replacement include male gender, younger age at disruption, and associated branch pulmonary artery stenosis. There is a trend towards a shortened interval for the African-American race. These factors may help identify patients who are prone to a more rapid progression of right heart failure from free pulmonary insufficiency, possibly steering them toward more frequent follow-up or more aggressive heart failure medical regimens.