title: Pulmonary valve replacement in repaired tetralogy of Fallot: determinants of early postoperative adverse outcomes.
abstract: OBJECTIVE
  We sought to examine the frequency of early postoperative complications and preoperative predictors of prolonged hospitalization in adults with repaired tetralogy of Fallot undergoing pulmonary valve replacement.
  
  
  METHODS
  This was a retrospective study of consecutive adult patients undergoing surgical intervention between 1995 and 2006. A multivariate logistic regression model was used to identify determinants of prolonged hospitalization.
  
  
  RESULTS
  One hundred sixteen patients (mean age, 36 +/- 11 years) underwent 118 pulmonary valve replacements. Most (95%) operations included additional procedures, such as pulmonary artery/outflow tract reconstruction or tricuspid valve annuloplasty. The early postoperative mortality (<30 days) was 2.5%. The majority of the patients (60%) had no postoperative complications. The postoperative adverse events included postoperative arrhythmias (19%), respiratory complications (13%), reoperation during admission (13%), renal dysfunction (13%), and myocardial infarction (3%). Postoperative adverse events were associated with prolonged hospitalization (14 +/- 12 vs 7 +/- 3 days, P = .001). In the multivariate analysis age at reoperation of greater than 45 years (odds ratio, 6.1; 95% confidence interval, 1.6-23.6; P = .009), the number of previous sternotomies (odds ratio, 3.8; 95% confidence interval, 1.4-10; P = .007), and the need for urgent surgical intervention (odds ratio, 5.7; 95% confidence interval, 1.1-27.8; P = .03) were predictors of prolonged hospitalization.
  
  
  CONCLUSIONS
  Pulmonary valve replacement in adults with repaired tetralogy of Fallot has a low mortality risk. The most common early postoperative complications are arrhythmias and respiratory and renal complications. Although most early postoperative complications do not result in long-term sequelae, they are associated with prolonged hospitalization. Patients undergoing urgent interventions, older patients, and those with multiple previous sternotomies are at the highest risk for prolonged hospitalization.
authors.affiliation: Toronto Congenital Cardiac Center for Adults, Toronto General Hospital/University Health Network, Toronto, Ontario, Canada. laura_dos_subira@hotmail.com
authors.forename: Laura
authors.initials: L
authors.lastname: Dos
authors.forename: Alexander
authors.initials: A
authors.lastname: Dadashev
authors.forename: David
authors.initials: D
authors.lastname: Tanous
authors.forename: Ignacio J
authors.initials: IJ
authors.lastname: Ferreira-González
authors.forename: Kim
authors.initials: K
authors.lastname: Haberer
authors.forename: Samuel C
authors.initials: SC
authors.lastname: Siu
authors.forename: Glen S
authors.initials: GS
authors.lastname: Van Arsdell
authors.forename: Erwin N
authors.initials: EN
authors.lastname: Oechslin
authors.forename: William G
authors.initials: WG
authors.lastname: Williams
authors.forename: Candice K
authors.initials: CK
authors.lastname: Silversides
mesh_terms: D000328:Adult; D001145:Arrhythmias, Cardiac / Q000453:epidemiology / Q000209:etiology; D013504:Cardiovascular Surgical Procedures / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D015994:Incidence; D007674:Kidney Diseases / Q000453:epidemiology / Q000209:etiology; D007902:Length of Stay / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000453:epidemiology / Q000209:etiology; D016017:Odds Ratio; D010166:Palliative Care / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology*; D011664:Pulmonary Valve / Q000601:surgery*; D012086:Reoperation; D012140:Respiratory Tract Diseases / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D013771:Tetralogy of Fallot / Q000601:surgery*