title: Pulmonary valve replacement with mechanical prostheses in re-do Fallot patients.
abstract: In this prospective clinical study, we have compared 17 patients with tetralogy of Fallot (TOF) who received mechanical valve substitutes and had concomitant additional right ventricular (RV) volume reduction plasty (aRVVRP, group 1) with seven patients who underwent solitary re-do pulmonary valve replacements (PVR, group 2). All patients were evaluated by magnetic resonance imaging (MRI) two months pre- and four to six months postoperatively for assessment of ventricular geometry. At a mean follow-up of 31.9 months, the RV ejection fraction improved from 39.1 to 48.3% in group 1 vs. from 40.1 to 49% in group 2 (P<0.001), and RV indexed end-diastolic volume decreased from 174.8 to 119.9 ml/m(2) (group 1) vs. from 142.4 to 99.6 ml/m(2) (group 2, P<0.001). Indexed RV myocardial mass decreased from 52.3 to 38.7 g/m(2) in group 1 vs. 46.9 to 39.1 g/m(2) in group 2 (P<0.001). Follow-up revealed no mortality and distinct improvements in RV geometry, recommending mechanical prostheses as suitable alternatives for PVR. Selection criteria for this solution should consider multiple previous reoperations and assured patient compliance in terms of current anticoagulant usage and self-testing. aRVVRP could serve as an adjunct in re-dos of TOF surgery indicated by RV outflow tract dysfunction due to akinetic fibrous areas.
authors.affiliation: Division of Cardiac Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29, A-8036 Graz, Austria.
authors.forename: Ismar
authors.initials: I
authors.lastname: Ovcina
authors.forename: Igor
authors.initials: I
authors.lastname: Knez
authors.forename: Pero
authors.initials: P
authors.lastname: Curcic
authors.forename: Sezen
authors.initials: S
authors.lastname: Ozkan
authors.forename: Bert
authors.initials: B
authors.lastname: Nagel
authors.forename: Erich
authors.initials: E
authors.lastname: Sorantin
authors.forename: Markus
authors.initials: M
authors.lastname: Puchinger
authors.forename: Karlheinz
authors.initials: K
authors.lastname: Tscheliessnigg
mesh_terms: D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D001317:Austria; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000295:instrumentation; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging; D008297:Male; D018579:Patient Selection; D011446:Prospective Studies; D011474:Prosthesis Design; D011664:Pulmonary Valve / Q000503:physiopathology / Q000601:surgery*; D011665:Pulmonary Valve Insufficiency / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D020127:Recovery of Function; D012086:Reoperation; D013318:Stroke Volume; D013771:Tetralogy of Fallot / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D016278:Ventricular Function, Right; D020257:Ventricular Remodeling; D055815:Young Adult