Document Detail


Outcome of pulmonary valve replacements in adults after tetralogy repair: a multi-institutional study.
MedLine Citation:
PMID:  18557878     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: The purpose of this study was to assess the outcome of pulmonary valve replacement (PVR) in adults with moderate/severe pulmonary regurgitation after tetralogy repair, with particular emphasis on patient outcome, durability of valve repair, and improvement in symptomatology.
DESIGN/SETTING/PATIENTS: The project committee of the International Society of Congenital Heart Disease undertook a retrospective multi-institutional analysis of PVR. Seven centers participated in submitting data on 93 patients >18 years of age who had the operation performed and follow-up obtained. The average age of PVR was 26+/- years (median 27 years). Time of follow-up after replacement was 3 years (range 4 days-28 years). OUTCOMES/MEASURES/RESULTS: Kaplan-Meier estimates of durability of PVR showed approximately 50% replacement at 11 years. There were two deaths at 6 and 12 months after valve replacement. Right ventricular (RV) size estimated by echocardiography from pre- to postoperative studies decreased in 81% (P < 0.001 testing for equal proportions), but RV systolic function increased in only 36% (P = 0.09). Ability index improved in 59% (P < 0.001) and clinical heart failure status improved in 57% with this problem before PVR. PVR did not improve arrhythmia status in a small group of patients.
CONCLUSIONS: PVR is associated with low mortality, decrease in RV size and improvement in ability index, and uncertain effects on RV systolic function. Average valve durability was approximately 11 years. Criteria for PVR that will preserve RV function are not clearly identified, and management of these patients remains a difficult enterprise.
Authors:
Thomas P Graham; Yvonne Bernard; Patrick Arbogast; Sravan Thapa; Frank Cetta; John Child; Reema Chugh; William Davidson; Roger Hurwitz; Joseph Kay; Stephen Sanders; Maria Schaufelberger
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Publication Detail:
Type:  Clinical Trial; Journal Article; Multicenter Study    
Journal Detail:
Title:  Congenital heart disease     Volume:  3     ISSN:  1747-0803     ISO Abbreviation:  Congenit Heart Dis     Publication Date:    2008 May-Jun
Date Detail:
Created Date:  2008-06-18     Completed Date:  2008-08-26     Revised Date:  2011-05-05    
Medline Journal Info:
Nlm Unique ID:  101256510     Medline TA:  Congenit Heart Dis     Country:  United States    
Other Details:
Languages:  eng     Pagination:  162-7     Citation Subset:  IM    
Affiliation:
Department of Pediatrics Division of Cardiology, Vanderbilt University, Nashville, TN 37232, USA. tom.graham@vanderbilt.edu
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Child
Child, Preschool
Female
Heart Valve Prosthesis Implantation*
Humans
Infant
Infant, Newborn
Male
Pulmonary Valve / surgery*
Pulmonary Valve Insufficiency / etiology,  surgery*
Retrospective Studies
Severity of Illness Index
Tetralogy of Fallot / complications,  surgery*
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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