title: Long-term follow-up after pulmonary valve replacement in repaired tetralogy of Fallot.
abstract: Surgical pulmonary valve replacement (PVR) in previously repaired tetralogy of Fallot (TOF) is frequently required. There are few data in large series of patients with long-term follow-up. Our aim was to review our 40-year experience with PVR after TOF repair and to evaluate prognostic factors for reintervention and death. Between 1973 and 2012, 278 patients with repaired TOF (53% men; 31.4 ± 16.4 years) underwent first PVR 24 ± 13 years after TOF repair. Three or more previous operations were performed in 17% of the patients, and 42% were in New York Heart Association (NYHA) class III/IV. PVR types included porcine (n = 211), pericardial (n = 37), homograft (n = 27), and mechanical (n = 3). Early mortality was 1.4%. Mean follow-up was 7.3 ± 6.8 years (maximum, 34 years). Overall survival at 5, 10, and 15 years was 93%, 83%, and 80% compared with 99%, 97%, and 95% in a gender- and age-matched US population, p <0.001. Independent risk factors for death were older age at complete repair (hazards ratio [HR] 1.2, p = 0.012), ≥ 3 previous cardiac operations (HR 1.9, p = 0.019), NYHA class III/IV at PVR (HR 2.7, p = 0.019), and large body surface area at PVR (HR 1.9, p <0.001). Reintervention after initial PVR occurred in 25 patients. Overall 5, 10, and 15 years freedom from pulmonary valve reintervention was 97%, 85%, and 75%, respectively. Multivariate analysis demonstrated older age at PVR to be protective from reintervention (HR 0.7, p <0.001). In conclusion, PVR is a safe operation with a low rate of reintervention in repaired TOF. The total number of cardiac operations, surgical timing, and the NYHA classification before PVR are important prognostic factors.
authors.affiliation: Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota; Departament de Pediatria, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Anna
authors.initials: A
authors.lastname: Sabate Rotes
authors.affiliation: Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Benjamin W
authors.initials: BW
authors.lastname: Eidem
authors.affiliation: Division of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota.
authors.forename: Heidi M
authors.initials: HM
authors.lastname: Connolly
authors.affiliation: Division of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota.
authors.forename: Crystal R
authors.initials: CR
authors.lastname: Bonnichsen
authors.affiliation: Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota.
authors.forename: Jordan K
authors.initials: JK
authors.lastname: Rosedahl
authors.affiliation: Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.
authors.forename: Hartzell V
authors.initials: HV
authors.lastname: Schaff
authors.affiliation: Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Dearani
authors.affiliation: Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota. Electronic address: burkhart.harold@gmail.com.
authors.forename: Harold M
authors.initials: HM
authors.lastname: Burkhart
mesh_terms: D000328:Adult; D006348:Cardiac Surgical Procedures; D002675:Child, Preschool; D004452:Echocardiography; D005500:Follow-Up Studies; D005544:Forecasting; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D007223:Infant; D008297:Male; D011664:Pulmonary Valve / Q000002:abnormalities / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D013771:Tetralogy of Fallot / Q000175:diagnosis / Q000601:surgery*