TY - JOUR
T1 - Mild residual pulmonary stenosis in tetralogy of fallot reduces risk of pulmonary valve replacement
AU - van der Hulst, Annelies E.
AU - Hylkema, Marije G.
AU - Vliegen, Hubert W.
AU - Delgado, Victoria
AU - Hazekamp, Mark G.
AU - Rijlaarsdam, Marry E. B.
AU - Holman, Eduard R.
AU - Blom, Nico A.
AU - Roest, Arno A. W.
PY - 2012
Y1 - 2012
N2 - Current surgical strategies that aim at preventing pulmonary regurgitation in patients with corrected tetralogy of Fallot (cToF) may result in a certain grade of residual pulmonary stenosis (PS). The clinical implications of a postoperative residual PS in cToF patients remain unclear. Pulmonary valve replacement (PVR) is frequently needed during follow-up of cToF patients. The aim of the current study was to determine the role of residual PS in the need for PVR during follow-up in cToF patients. cToF patients were included if clinical follow-up after primary surgical correction had taken place for a minimum of 5 years. Patient characteristics, surgical factors, and postoperative factors were reviewed, with a special focus on the transpulmonic systolic gradient. Cox proportional hazards regression analysis was performed to identify predictors of PVR. Of 171 cToF patients, 71 (41.5%) underwent PVR after 24.2 years (interquartile range, 16.8-31.6 years). Year of birth, older age at corrective operation, and patch use significantly predicted PVR during follow-up. By contrast, a mild residual PS in cToF patients (peak systolic gradient, 15-30 mm Hg) independently reduced the risk of PVR, as compared with patients without PS (hazard ratio, 0.47; p = 0.02) and with moderate-to-severe PS (hazard ratio, 0.35; p = 0.01). In addition to the known risks factors for PVR, a postoperative mild residual PS reduces the risk of PVR during follow-up of cToF patients. This finding provides clinical evidence for a conservative PS relief during correction of ToF
AB - Current surgical strategies that aim at preventing pulmonary regurgitation in patients with corrected tetralogy of Fallot (cToF) may result in a certain grade of residual pulmonary stenosis (PS). The clinical implications of a postoperative residual PS in cToF patients remain unclear. Pulmonary valve replacement (PVR) is frequently needed during follow-up of cToF patients. The aim of the current study was to determine the role of residual PS in the need for PVR during follow-up in cToF patients. cToF patients were included if clinical follow-up after primary surgical correction had taken place for a minimum of 5 years. Patient characteristics, surgical factors, and postoperative factors were reviewed, with a special focus on the transpulmonic systolic gradient. Cox proportional hazards regression analysis was performed to identify predictors of PVR. Of 171 cToF patients, 71 (41.5%) underwent PVR after 24.2 years (interquartile range, 16.8-31.6 years). Year of birth, older age at corrective operation, and patch use significantly predicted PVR during follow-up. By contrast, a mild residual PS in cToF patients (peak systolic gradient, 15-30 mm Hg) independently reduced the risk of PVR, as compared with patients without PS (hazard ratio, 0.47; p = 0.02) and with moderate-to-severe PS (hazard ratio, 0.35; p = 0.01). In addition to the known risks factors for PVR, a postoperative mild residual PS reduces the risk of PVR during follow-up of cToF patients. This finding provides clinical evidence for a conservative PS relief during correction of ToF
U2 - https://doi.org/10.1016/j.athoracsur.2012.06.065
DO - https://doi.org/10.1016/j.athoracsur.2012.06.065
M3 - Article
C2 - 22981253
SN - 0003-4975
VL - 94
SP - 2077
EP - 2082
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
IS - 6
ER -