Clinical Outcomes of Surgical Pulmonary Valve Replacement after Repair of Tetralogy of Fallot and Potential Prognostic Value of Preoperative Cardiopulmonary Exercise Testing
Background—Indications for surgical pulmonary valve replacement (PVR) after repair of tetralogy of Fallot (rTOF) have recently been broadened to include asymptomatic patients.
Methods and Results—The outcome of PVR in adults after rTOF at a single tertiary centre was retrospectively studied. Preoperative cardiopulmonary exercise (CPEX) testing was included. Mortality was the primary outcome measure. Two-hundred-and-twenty-one PVRs were performed in 220 patients (130 male, median age 32, range 16-64 years). Homografts were used in 117, xenografts in 103 and a mechanical valve in 1 case. Early (30-day) mortality was 2%. Overall survival was 97% at one year, 96% at 3 years and 92% at 10 years. Survival after PVR in the later era (2005-2010;n=156) was significantly better compared to survival in the earlier era (1993-2004;n=65), [99% versus 94% at 1 year and 98% versus 92% at 3 years, respectively,P=0.019]. Earlier era patients were more symptomatic preoperatively (P=0.036) with a lower preoperative peak oxygen consumption (peak VO2,P<0.001). Freedom from redo surgical or transcatheter PVR was 98% at 5 years, and 96% at 10 years for the whole cohort. Peak VO2, VE/VCO2 slope and heart rate reserve during CPEX testing predicted risk of early mortality when analyzed with logistic regression analysis; peak VO2 emerged as the strongest predictor amongst them on multivariable analysis (Odds ratio 0.65 per ml/kg/min,P=0.041).
Conclusions—PVR after rTOF has a low and improving mortality, with low need for re-intervention. Preoperative cardiopulmonary exercise testing predicts surgical outcome and should therefore be included in the routine assessment of these patients
- pulmonary regurgitation
- cardiopulmonary exercise testing
- tetralogy of Fallot
- congenital cardiac defect
- exercise test
- Received February 1, 2013.
- Revision received September 24, 2013.
- Accepted October 1, 2013.