Background
: Pulmonary regurgitation (PR) in repaired tetralogy of Fallot (TOF) is associated with right ventricular (RV) dilation and dysfunction as well as arrhythmia. Pulmonary valve replacement (PVR) may prevent the development of these late complications. This retrospective study tests the hypothesis that PVR improves survival and freedom from ventricular tachycardia (VT) in patients with TOF.
Methods
: Enrolled patients had TOF with PVR for RV dilation from PR. Referral for PVR was largely based on symptoms. Controls (TOF patients with RV dilation
but no PVR
), were matched by age (± 2 years) and QRS duration (± 30 msec). There were 77 case/control pairs. Pairs did not differ significantly for age, repair type, decade of TOF repair, age at TOF repair, or presence of pre-PVR VT. Primary outcome events were death and VT. Events were recorded only if they occurred while both case/control were actively followed. Total duration of post-PVR follow-up was 172 patient years per group (median 1.4y, 0.01 – 13.2). PVRs were performed between 1990 and 2005 at median age 21y (6 –57).
Results:
The change in QRS duration did not differ significantly between the two groups (p = 0.43). Other results are summarized in the table
and figure
below.
Conclusion:
In this cohort of patients with repaired TOF, late PVR for symptomatic PR/RV dilation did not lead to reduced incidence of VT and/or death.
The change of QRS duration after pulmonary valve replacement in patients with repaired tetralogy of Fallot and pulmonary regurgitation
