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Individualised prediction of pulmonary homograft durability in tetralogy of Fallot.
- Source :
- Heart; Nov2015, Vol. 101 Issue 21, p1695-1696, 2p, 1 Chart
- Publication Year :
- 2015
-
Abstract
- <bold>Background: </bold>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.<bold>Methods: </bold>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.<bold>Results: </bold>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).<bold>Conclusions: </bold>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. [ABSTRACT FROM AUTHOR]
- Subjects :
- PULMONARY artery
PULMONARY valve
AGE distribution
HEART ventricle diseases
CARDIOVASCULAR surgery
ECHOCARDIOGRAPHY
HOMOGRAFTS
RIGHT heart ventricle
HEALTH outcome assessment
COMPLICATIONS of prosthesis
REOPERATION
RISK assessment
SURGICAL complications
TETRALOGY of Fallot
PROPORTIONAL hazards models
RETROSPECTIVE studies
DIAGNOSIS
SURGERY
Subjects
Details
- Language :
- English
- ISSN :
- 13556037
- Volume :
- 101
- Issue :
- 21
- Database :
- Complementary Index
- Journal :
- Heart
- Publication Type :
- Academic Journal
- Accession number :
- 110638939
- Full Text :
- https://doi.org/10.1136/heartjnl-2015-308294