title: Long-term outcomes after definitive repair for tetralogy of Fallot with preservation of the pulmonary valve annulus.
abstract: OBJECTIVE
  The aim of our study was to evaluate the long-term outcomes after definitive repair of tetralogy of Fallot with preservation of the pulmonary valve (PV) annulus.
  
  
  METHODS
  From 1989 to 2000, 84 of 222 patients (37.8%) with tetralogy of Fallot and PV stenosis underwent definitive repair with preservation of the PV annulus without right ventriculotomy. PV commissurotomy was concomitantly performed in 74 patients (88.1%). The PV was bicuspid in 56 patients (66.7%); the mean Z value was -1.2 ± 1.5 (range, -4.9 to 2.4). The mean follow-up period was 15.8 ± 5.7 years (maximum, 22.8), and follow-up data were complete for 75 patients (89.3%).
  
  
  RESULTS
  The actuarial survival and freedom from reoperation rates at 20 years was 98.6% and 95.8%. The freedom from ventricular arrhythmia at 5, 10, 15, and 20 years was 98.7%, 89.6%, 74.1%, and 58.0%, respectively. All detected ventricular arrhythmias were isolated monofocal premature ventricular contractions. Freedom from moderate or greater pulmonary regurgitation at 5, 10, 15 and 20 years was 50.4%, 44.9%, 38.4%, and 35.7%, respectively. A bicuspid PV (hazard ratio, 2.910; 95% confidence interval, 1.404-6.204, P = .004) and a Z-value of less than -2 (hazard ratio, 1.948; 95% confidence interval, 0.915-5.857; P = .034) were the risk factors for developing moderate or greater pulmonary regurgitation.
  
  
  CONCLUSIONS
  The long-term outcomes after definitive repair of tetralogy of Fallot with preservation of the PV annulus were excellent. Although isolated, monofocal premature ventricular contractions were frequently observed, fatal ventricular arrhythmia was not. The indication should not only be decided by the PV annulus size, but also by the valvular morphology to maintain long-term PV competency.
authors.affiliation: Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan. Electronic address: thoashi@surg1.med.osaka-u.ac.jp.
authors.forename: Takaya
authors.initials: T
authors.lastname: Hoashi
authors.affiliation: Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Kagisaki
authors.affiliation: Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
authors.forename: Yin
authors.initials: Y
authors.lastname: Meng
authors.affiliation: Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
authors.forename: Heima
authors.initials: H
authors.lastname: Sakaguchi
authors.affiliation: Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Kurosaki
authors.affiliation: Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
authors.forename: Isao
authors.initials: I
authors.lastname: Shiraishi
authors.affiliation: Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
authors.forename: Toshikatsu
authors.initials: T
authors.lastname: Yagihara
authors.affiliation: Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
authors.forename: Hajime
authors.initials: H
authors.lastname: Ichikawa
mesh_terms: D001145:Arrhythmias, Cardiac / Q000209:etiology / Q000601:surgery; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D053208:Kaplan-Meier Estimate; D008297:Male; D016016:Proportional Hazards Models; D011664:Pulmonary Valve / Q000503:physiopathology / Q000601:surgery*; D011665:Pulmonary Valve Insufficiency / Q000209:etiology / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000401:mortality; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013771:Tetralogy of Fallot / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome