TY - JOUR
TI - Pulmonary valve replacement in patients with corrected tetralogy of
Fallot
AU - Mitropoulos, Fotios A.
AU - Kanakis, Meletios A.
AU - Ntellos, Christos
AU - and Loukas, Constantinos
AU - Davlouros, Periklis
AU - Kousi, Theophili
AU - and Chatzis, Andrew C.
JO - JOURNAL OF CARDIOVASCULAR AND THORACIC RESEARCH
PY - 2017
VL - 9
TODO - 2
SP - 71-77
PB - TABRIZ UNIV MEDICAL SCIENCES & HEALTH SERVICES
SN - null
TODO - 10.15171/jcvtr.2017.12
TODO - Adult Congenital Heart Disease; Congenital Heart Surgery; Pulmonary
Valve; Reoperation
TODO - Introduction: Development of pulmonary insufficiency in patients with
surgically corrected tetralogy of Fallot (TOF) may lead to severe right
heart failure with serious consequences. We herein present our
experience with pulmonary valve replacement (PVR) in these patients.
Methods: From 2005-2013, 99 consecutive patients (71 males/28 females,
mean age 38 +/- 8 years), underwent PVR after 7 to 40 (mean 29 +/- 8)
years from the initial correction. Seventy nine of the symptomatic
patients presented in NYHA II, 14 in III and 2 in IV. All underwent PVR
with a stented bioprosthetic valve, employing a beating heart technique
with normothermic extracorporeal circulation support. Concomitant
procedures included resection of aneurysmal outflow tract patches (n =
37), tricuspid valve annuloplasty (n = 36), augmentation of stenotic
pulmonary arteries (n = 9), maze procedure (n = 2) and pulmonary artery
stenting (n = 4).
Results: There were 2 perioperative deaths (2%). One patient developed
sternal dehiscence requiring rewiring. Median ICU and hospital stay was
1 and 7 days respectively. Postoperative echocardiography at 6 and 12
months showed excellent bioprosthetic valve performance, significant
decrease in size of the right cardiac chambers and reduction of
tricuspid regurgitation (TR) in the majority of the patients. At mean
follow-up of 3.6 +/- 2 years, all surviving patients remain in excellent
clinical condition.
Conclusion: Probability of reoperation for pulmonary insufficiency in
patients with surgically corrected TOF increases with time and timely
PVR by preventing the development of right heart failure is crucial for
long-term survival. Current bioprosthetic valve technology in
combination with the beating heart technique provides excellent
immediate and short-term results. Further follow-up is necessary to
evaluate long-term outcome.
ER -