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Intermediate-term Follow-up of Bioprosthetic Valve Function after Pulmonary Valve Implantation in Repaired Tetralogy of Fallot Patients.
Won Young Lee, Eun Seok Choi, Chun Soo Park, Tae-Jin Yun
Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Republic of Korea
Purpose : Although tissue valves in pulmonary position are known to be durable, prosthetic valve failure and reoperation are not infrequent. We sought to analyze the intermediate-term outcomes after bioprosthetic pulmonary valve implantation (PVI).
Methods : From January 2005 to July 2017, PVI using tissue valve was performed in 77 patients with previous ToF repair. There was no early mortality. Follow up data was complete in 72 patients (72/77, 93%). Median follow-up duration after PVI was 3.5 years (range: 1 month to 12.4 years), and median interval between PVI and last echocardiographic examination was 1.9 years (range: 1 month to 11.3 years). Cox proportional hazards model was fitted to identify risk factors for prosthetic valve dysfunction (PVD) after PVI.
Results : Fifteen patients developed PVD (structural deterioration in 10, nonstructural dysfunction in 5), and four patients underwent repeat PVI. Freedom from valvular dysfunction and repeat PVI were 78.9% / 91.6% at 5 years. After PVI, residual anatomic lesions were identified in 18 patients, including significant tricuspid regurgitation (n=11), residual ventricular septal defects (n=1), aortic regurgitation (n=5), and supravalvar pulmonary stenosis (n=1). On Cox model, residual anatomic lesions was identified as a risk factor for decreased time to valve dysfunction (HR=3.41; 95% CI, 1.20-9.77; P = 0.02).
Conclusion : Considering the lower risk of repeat PVI rate, using bioprosthetic valve for PVI in patients with previous ToF repair seems reasonable. However, prosthetic valve dysfunction develops not infrequently, particularly in patients with residual anatomic lesions.
Methods : From January 2005 to July 2017, PVI using tissue valve was performed in 77 patients with previous ToF repair. There was no early mortality. Follow up data was complete in 72 patients (72/77, 93%). Median follow-up duration after PVI was 3.5 years (range: 1 month to 12.4 years), and median interval between PVI and last echocardiographic examination was 1.9 years (range: 1 month to 11.3 years). Cox proportional hazards model was fitted to identify risk factors for prosthetic valve dysfunction (PVD) after PVI.
Results : Fifteen patients developed PVD (structural deterioration in 10, nonstructural dysfunction in 5), and four patients underwent repeat PVI. Freedom from valvular dysfunction and repeat PVI were 78.9% / 91.6% at 5 years. After PVI, residual anatomic lesions were identified in 18 patients, including significant tricuspid regurgitation (n=11), residual ventricular septal defects (n=1), aortic regurgitation (n=5), and supravalvar pulmonary stenosis (n=1). On Cox model, residual anatomic lesions was identified as a risk factor for decreased time to valve dysfunction (HR=3.41; 95% CI, 1.20-9.77; P = 0.02).
Conclusion : Considering the lower risk of repeat PVI rate, using bioprosthetic valve for PVI in patients with previous ToF repair seems reasonable. However, prosthetic valve dysfunction develops not infrequently, particularly in patients with residual anatomic lesions.
첨부파일 : 소아분야초록.template.pptx
책임저자: Tae-Jin Yun
Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Republic of Korea
발표자: Won Young Lee, E-mail : william330@naver.com