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Individualised prediction of pulmonary homograft durability in tetralogy of Fallot.
- Source :
-
Heart (British Cardiac Society) [Heart] 2015 Nov; Vol. 101 (21), pp. 1717-23. Date of Electronic Publication: 2015 Jul 14. - Publication Year :
- 2015
-
Abstract
- Background: In patients with repaired tetralogy of Fallot (rTOF), multiple reoperations or percutaneous interventions after pulmonary valve replacement (PVR) may be necessary due to limited homograft durability. However, data to guide individualised prediction of homograft durability remain scarce. The aim of this study was to provide risk models for RV to pulmonary artery homograft durability.<br />Methods: This retrospective multicentre study included consecutive patients with rTOF who had undergone PVR at an age of >12 years. Homograft dysfunction was defined as at least moderate pulmonary regurgitation (PR) or pulmonary stenosis (PS) (pressure gradient ≥36 mm Hg) as assessed by echocardiography. Reintervention was defined as percutaneous intervention or redo-PVR.<br />Results: A total of 153 patients with rTOF were included (62% male, mean age at PVR 31±11 years, pulmonary homograft 96%, follow-up 9.6 years (IQR 5.9, 13.3)). Average freedom from homograft dysfunction and reintervention after 10 years was 74% and 89%, respectively. In multivariable Cox proportional hazards analysis, postoperative PS ≥20 mm Hg (HR 6.52, 95% CI 3.09 to 13.7), postoperative PR ≥ grade 1 (HR 3.13, 95% CI 1.45 to 6.74) and age at PVR <18 years (HR 3.52, 95% CI 1.64 to 7.53) were independently predictive for homograft dysfunction. In patients without any risk factor, 10-year freedom from homograft dysfunction and reintervention was excellent (91% and 96%, respectively) in contrast to patients with ≥2 risk factors (25% and 73%, respectively).<br />Conclusions: Individualised prediction of homograft durability in patients with rTOF can be guided by early postoperative echocardiography. In adult patients without early postoperative PS or PR, homograft dysfunction and reintervention are unlikely to occur within 10 years, and follow-up may be less stringent.<br /> (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)
- Subjects :
- Adult
Age Factors
Allografts physiopathology
Echocardiography methods
Female
Humans
Male
Netherlands epidemiology
Outcome Assessment, Health Care
Proportional Hazards Models
Prosthesis Failure
Reoperation methods
Reoperation statistics & numerical data
Retrospective Studies
Risk Assessment
Tetralogy of Fallot epidemiology
Tetralogy of Fallot physiopathology
Transplantation, Homologous methods
Cardiovascular Surgical Procedures adverse effects
Cardiovascular Surgical Procedures methods
Postoperative Complications diagnosis
Postoperative Complications physiopathology
Postoperative Complications surgery
Pulmonary Artery surgery
Pulmonary Valve surgery
Tetralogy of Fallot surgery
Ventricular Dysfunction, Right diagnosis
Ventricular Dysfunction, Right etiology
Ventricular Dysfunction, Right physiopathology
Ventricular Dysfunction, Right surgery
Subjects
Details
- Language :
- English
- ISSN :
- 1468-201X
- Volume :
- 101
- Issue :
- 21
- Database :
- MEDLINE
- Journal :
- Heart (British Cardiac Society)
- Publication Type :
- Academic Journal
- Accession number :
- 26175476
- Full Text :
- https://doi.org/10.1136/heartjnl-2015-307754