Risk factors for arrhythmia and late death in patients with right ventricle to pulmonary artery conduit repair--Japanese multicenter study.
BACKGROUND
Arrhythmia and late cardiac deaths are thought to be major complications in patients after right ventricle (RV) to pulmonary artery (PA) conduit repair, although the incidence and predictors of these complications remain unknown. The aim of this study was to clarify the incidence and risk factors for arrhythmia and late deaths in patients with the RV to PA conduit repair through a Japanese multicenter study.


METHODS
Three hundred fifty-one hospital survivors who underwent the RV to PA conduit repair before 1995 were studied.


RESULTS
Survival rate after repair was 92% at 10 years, 88% at 20 and 25 years, respectively. Late death was observed in 30 (8.5%) including 4 patients with sudden death (SD). Higher right ventricular pressure (p = 0.02), larger cardio-thoracic ratio after repair (p = 0.02) and higher incidence of brady- or tachy-arrhythmia and SD (9/30) were associated with late death. Six (1.7%) patients developed ventricular tachycardia or ventricular fibrillation (VT/Vf). There were 22 patients who had 23 new-onset supraventricular tachy-arrhythmia (SVT). Right ventricular hypertension (p = 0.04) was associated with VT/Vf or SD. Male sex (p < 0.01), absence of previously aorto-pulmonary shunt (p < 0.05), older age at repair (p < 0.01) or longer length of follow-up (p < 0.01) were associated with SVT.


CONCLUSIONS
Arrhythmia and late sudden death are relatively common late after the RV to PA conduit repair. Our data support recent surgical strategies of earlier primary operation and timely reoperation for progressive right ventricular outflow stenosis that may reduce the incidence of late arrhythmias and SD.
Tateno
Shigeru
S
Department of Pediatrics, Chiba Cardiovascular Center, Chiba, 575 Tsurumai, Ichihara-shi, Chiba, 290-0512, Japan. tatenoji@sa2.so.net.ne.jp
Niwa
Koichiro
K
Nakazawa
Makoto
M
Iwamoto
Mari
M
Yokota
Michio
M
Nagashima
Masami
M
Echigo
Shigeyuki
S
Kado
Hideaki
H
Shima
Masayuki
M
Gatzoulis
Michael A
MA
D000293:Adolescent; D000328:Adult; D001145:Arrhythmias, Cardiac / Q000209:etiology / Q000401:mortality*; D013504:Cardiovascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality*; D002648:Child; D002675:Child, Preschool; D016757:Death, Sudden, Cardiac / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006330:Heart Defects, Congenital / Q000150:complications / Q000401:mortality* / Q000601:surgery; D006801:Humans; D015994:Incidence; D007223:Infant; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D014694:Ventricular Outflow Obstruction / Q000150:complications / Q000401:mortality / Q000601:surgery