Abstract 15995: Survival and Reintervention After Pulmonary Valve Replacement in Tetralogy of Fallot
Background: Surgical pulmonary valve replacement (PVR) in previously repaired tetralogy of Fallot (TOF) is frequently required. There are few data on large numbers of patients with long follow-up. Our aim was to review our 40-year experience with PVR after TOF repair, and evaluate prognostic factors for need of pulmonary valve reintervention and death.
Methods and Results: Between April 1973 and September 2012 (68% after 2000), 278 patients with repaired TOF (53% males; 31.4±16.4 years of age) underwent first PVR 24±13 years after TOF repair. Three or more prior operations were performed in 17% of the patients and 42% were NYHA class III/IV. Patients with previous conduit or PVR, a diagnosis of pulmonary atresia, absent pulmonary valve and/or concomitant atrioventricular septal defect were excluded. PVR types included porcine (n=211), pericardial (n=37), homograft (n=27) and mechanical (n= 3). Associated procedures were performed in 199 patients. Valve size (26.8±2.9mm) positively correlated with age and BSA (p<0.001). 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%, respectively. Independent risk factors for death were older age at complete repair (hazard ratio [HR] 1.2, 95% confidence interval [CI] 1.03-1.3, p=0.012), ≥ 3 previous cardiac operations (HR 1.9, 95% CI 1.1-3.1, p = 0.019), NYHA class III/IV at PVR (HR 2.7, 95% CI 1.2-6.1, p=0.019) and large BSA at PVR (HR 1.9, 95% CI 1.4-2.5, p<0.001). Reintervention after initial PVR occurred in 25 patients (9%); 22 underwent surgical re-PVR and 3 had transcatheter PVR. Mean time to reintervention was 7.8±4.6 years. Overall 5, 10 and 15 year 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, 95% CI 0.6-0.9, p<0.001).
Conclusion: PVR is a safe operation with a low rate of reintervention in repaired tetralogy of Fallot. The total number of cardiac operations, surgical timing, and the NYHA classification prior to PVR are important prognostic factors.
- © 2013 by American Heart Association, Inc.