Valve-sparing repair in tetralogy of Fallot: Does valve biology determine long-term outcome?

Background: Late pulmonary valve replacement following repair of tetralogy of Fallot may become necessary in patients with chronic pulmonary insufficiency. There is limited information on the long-term outcome of these prostheses, which is the focus of this study. Methods: We conducted a retrospective study of patients with repaired tetralogy of Fallot who underwent pulmonary valve replacement from 1990 to 2015 in our institution. We investigated imaging and clinical parameters including mortality and late adverse events (reintervention [surgical or transcatheter]), infective endocarditis, or arrhythmias requiring device implantation or ablation. Results: There were 69 patients divided into 3 groups: Carpentier-Edwards (n = 14), Contegra (n = 40), and pulmonary homograft (n = 15). The mean age at the time of pulmonary valve replacement was 21 ± 12 years. The mean follow-up was 8.5 ± 4.7 years. The mean preoperative and postoperative right ventricular end-diastolic volume index was 210 ± 42 and 120 ± 24 mL/m2, respectively. There were no mortalities. Late adverse events were observed in 23 (33%) patients: 15 (22%) reintervention (surgical or transcatheter), 11 (16%) endocarditis, and 11 (16%) arrhythmias. Overall, 1-, 5-, and 10-year freedom from surgical reintervention was 98.5%, 93.6%, and 79.3%, respectively. The Contegra group had significantly higher pulmonary valve gradients, a higher risk of developing late adverse events compared to Carpentier-Edwards ( P = .046) and pulmonary homograft ( P = .055) in multivariate analysis and increased risk for reintervention in the univariate analysis (hazard ratio: 3.4; 95% CI: 0.92-13; P value.066). Conclusion: Pulmonary valve replacement in patients with repaired tetralogy of Fallot has acceptable short- and intermediate-term outcomes. Contegra prosthesis had a higher risk of late adverse events with higher pulmonary valve gradients.

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Ventricular tachycardia and sudden cardiac death might complicate the long-term outcome by patients after tetralogy of Fallot repair

Orvosi Hetilap ◽

10.1556/oh.2008.28303 ◽

2008 ◽

Vol 149 (23) ◽

pp. 1067-1069

Author(s):

Attila Mihálcz ◽

Csaba Földesi ◽

Tamás Szili-Török

Keyword(s):

Ventricular Tachycardia ◽

Sudden Cardiac Death ◽

Tetralogy Of Fallot ◽

Cardiac Death ◽

Term Outcome ◽

Long Term Outcome ◽

Cardioverter Defibrillator ◽

Tetralogy Of Fallot Repair

A Fallot-tetralógia miatti műtétet követően a hosszú távú túlélést befolyásoló tényezők közé tartozik a kamrai tachycardia és a hirtelen szívhalál. E betegek gondozásában érdemi segítséget jelent az implantálható cardioverter defibrillátor rendszer. A végleges pacemaker és/vagy implantálható cardioverter defibrillátor implantációját követően ritka, ám potenciálisan letális kimenetelű fertőzéses szövődmény az endocarditis. Ez esetben a leghatékonyabb kezelési mód a kombinált terápia, amely a beültetett készülék + elektródák teljes körű eltávolításából és agresszív antibiotikus kezelésből áll. Célkitűzés: Ilyen esetekben a tervezett reimplantáció különös óvatosságot igényel a nagyobb recidívaarány miatt, amelynek rizikója fokozottabb pacemakerdependencia esetén. Célunk olyan módszer alkalmazása volt, amelynek segítségével a recidíva kockázata minimálisra csökkenthető. Módszer: Esetünkben a korábban Fallot-tetralógia miatt többször műtött, pacemaker-, majd implantálható cardioverter defibrillátor beültetéseken átesett betegnél recidív endocarditis miatt készülék- és elektródaeltávolítást végeztünk, standard antibiotikus terápia alkalmazásával. A reimplantációt minithoracotomián keresztül végeztük. Az így elhelyezett sokkelektróda elégtelen működése miatt egy másik sokkelektródát szubkután vezettünk a hátsó mellkasfali régióba; rendszerünk az indukált kamrafibrillációt sikerrel szüntette meg. Megbeszélés: Esetismertetésünk demonstrálja a szubkután defibrillátorrendszer alkalmazhatóságát és előnyeit speciális körülmények fennállásakor. Felhívjuk a figyelmet arra a tényre, hogy ezt a technikát gyakrabban is lehetne alkalmazni olyan esetekben, amelyekben a transzvénás implantáció nem optimális.

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Aortic valve-sparing root replacement in patients with bicuspid aortic valve: long-term outcome with the David I procedure over 20 years

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezaa083 ◽

2020 ◽

Vol 58 (1) ◽

pp. 86-93 ◽

Cited By ~ 3

Author(s):

Erik Beckmann ◽

Andreas Martens ◽

Heike Krüger ◽

Wilhelm Korte ◽

Tim Kaufeld ◽

...

Keyword(s):

Aortic Valve ◽

Bicuspid Aortic Valve ◽

Aortic Valves ◽

Term Outcome ◽

Long Term Outcome ◽

Initial Surgery ◽

Bicuspid Aortic Valves ◽

Valve Sparing

Abstract OBJECTIVES Aortic valve-sparing root replacement is an excellent treatment option for patients with intact tricuspid aortic valves. However, the durability in patients with bicuspid aortic valves is still a matter of debate. The aim of this study was to analyse the short- and long-term outcomes in patients with bicuspid aortic valves. METHODS Between July 1993 and October 2015, a total of 582 patients underwent the David I procedure, 50 of whom had a bicuspid aortic valve. In these patients, the mean age was 46 ± 13 years, and 80% (n = 40) were men. Follow-up was complete for 100% of patients and comprised a total of 552 patient-years with a mean follow-up time of 11 ± 5.2 years. RESULTS In addition to the David procedure, cusp plication was performed in 34% (n = 17) of patients and commissure repair in 8% (n = 4) of patients. There were no in-hospital deaths, and 1 patient (2%) had a perioperative stroke. The 1-, 5-, 10- and 20-year survival rates of patients after discharge were 98%, 94%, 88% and 84%, respectively. The rates for freedom from valve-related reoperation at 1, 5, 10 and 20 years after initial surgery were 98%, 88%, 79% and 74%, respectively. Long-term freedom from reoperation was comparable to that of patients with tricuspid aortic valves (P = 0.2). CONCLUSIONS The David procedure has excellent short-term results in patients with a bicuspid aortic valve. In this study, the long-term durability of reimplanted bicuspid aortic valves was comparable to that of tricuspid valves. However, careful patient selection might have contributed to this, and further studies might be needed to definitely clarify this issue.

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Determinants of short- and long-term outcome in the surgical correction of tetralogy of Fallot

Current Opinion in Pediatrics ◽

10.1097/00008480-199310000-00017 ◽

1993 ◽

Vol 5 (5) ◽

pp. 619-622 ◽

Cited By ~ 11

Author(s):

Andrew N. Redington

Keyword(s):

Tetralogy Of Fallot ◽

Surgical Correction ◽

Term Outcome ◽

Long Term Outcome ◽

Short And Long Term

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Long-Term Outcome After Total Correction of Tetralogy of Fallot in Adolescent and Adult Age

Journal of Cardiac Surgery ◽

10.1111/j.0886-0440.2005.200374df.x ◽

2005 ◽

Vol 20 (2) ◽

pp. 119-123 ◽

Cited By ~ 13

Author(s):

Hasan Basri Erdogan ◽

Nilgun Bozbuga ◽

Nihan Kayalar ◽

Vedat Erentug ◽

Suat Nail Omeroglu ◽

...

Keyword(s):

Tetralogy Of Fallot ◽

Total Correction ◽

Term Outcome ◽

Long Term Outcome ◽

Adult Age

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Commentary: The neglected chamber: Does the infundibulum make a difference in the long-term outcome of tetralogy of Fallot?

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/j.jtcvs.2020.10.113 ◽

2020 ◽

Author(s):

Alvise Guariento ◽

Christoph Haller

Keyword(s):

Tetralogy Of Fallot ◽

Term Outcome ◽

Long Term Outcome

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Aortic Valve–Sparing Root Replacement (David I Procedure) in Adolescents: Long-Term Outcome

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0039-1693654 ◽

2019 ◽

Author(s):

Erik Beckmann ◽

Andreas Martens ◽

Heike Krueger ◽

Wilhelm Korte ◽

Tim Kaufeld ◽

...

Keyword(s):

Aortic Valve ◽

Connective Tissue Diseases ◽

Young Patients ◽

Term Outcome ◽

Term Survival ◽

Long Term Outcome ◽

Initial Surgery ◽

Valve Sparing

Introduction Aortic valve-sparing root replacement (David's procedure) is an especially appealing treatment option for young patients. Here, we present the short-, mid, and long-term outcomes of this operation in adolescent patients. Methods Between September 1994 and March 2014, 29 patients aged 6 to 21 years underwent the David-I procedure at our center. We conducted a retrospective study with follow-up. Results The mean age was 16.8 ± 3.4 years and 90% (n = 26) were male. Marfan's syndrome was present in 86% (n = 25) of cases. Ninety-seven percent (n = 28) of cases were performed electively, and one case (3%) was performed emergently for acute aortic dissection type A. There were no early perioperative deaths (0%). Follow-up, which was completed on 100% of patients, comprised a total of 394 patient years and a mean follow-up time of 13.6 ± 5.4 years. The estimates for survival at 1, 5, and 10 years after initial surgery were 100, 97, and 93%, respectively. During follow-up, there were four (14%) late deaths and five (17%) aortic valve-related reoperations. The 1-, 5-, and 10-year estimates for freedom from valve-related reoperation were 100, 86, and 83%, respectively. The perioperative mortality for these five reoperations was 0%. Discussion Aortic valve–sparing root replacement can be performed in adolescents with a very low perioperative risk. Long-term survival seems to be affected by connective tissue diseases.

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