Effect of Pulmonary Valve Replacement in the Repaired Tetralogy of Fallot Patients with Trans-annular Incision: More than 20 Years of Follow-up

• Published in: Korean circulation journal Vol. 51; no. 4; pp. 360 - 372
• Main Authors: Kwak, Jae Gun, Shin, Hong Ju, Bang, Ji Hyun, Kim, Eung Re, Lee, Jeong Ryul, Kim, Woong Han, Bae, Eun Jung, Song, Mi Kyoung, Kim, Gi Beom
• Format: Journal Article
• Language: English
• Published: Korea (South) The Korean Society of Cardiology 01.04.2021; 대한심장학회
• Subjects: Original Research; 내과학; Tetralogy of Fallot; Congenital heart disease; Pulmonary valve; Pulmonary regurgitation
• ISSN: 1738-5520; 1738-5555
• DOI: 10.4070/kcj.2020.0331

We reviewed the long-term outcomes after tetralogy of Fallot (TOF) repair with trans-annular incision; and evaluated the effectiveness of pulmonary valve replacement (PVR) on outcomes. This was a retrospective review of clinical outcomes of 180 of 196 TOF patients who underwent total correction with trans-annular incision from 1991 to 1997 (PVR group: 81; non-PVR group: 99). The median age of the patients was 14.0 months (interquartile range [IQR], 10.7-19.8 months) at TOF repair. Ten in-hospital deaths (5.1%) occurred. During the follow-up, 81 patients underwent PVR at the median age of 13.5 years (IQR, 11.2-17.1 years). The patients in PVR group showed better outcomes than non-PVR group in overall survival rate (100% in PVR vs. 88.7% in non-PVR, p=0.007), in all adverse events (arrhythmia, neurologic complications, 95.5% in PVR vs. 74.6% in non-PVR, p=0.024) at 20 years. Age at TOF repair younger than 1 year (hazard ratio [HR], 2.265; p=0.01) and previous shunt history (HR, 2.195; p=0.008) were predictive for requiring PVR. During follow-up, 10 late deaths (5 sudden deaths) occurred in the non-PVR group, mainly due to ventricular arrhythmia and right ventricular failure; there was 1 late death (not a sudden death) in the PVR group. Long-term survival after repair of TOF with trans-annular incision were acceptable. However, arrhythmias were frequently observed during 20 years of follow-up. The patient age <1 year at the time of TOF repair and shunt implantation prior to TOF repair were predictive factors for requiring PVR.