Mid-term results of bioprosthetic pulmonary valve replacement in pulmonary regurgitation after tetralogy of Fallot repair

Abstract

Pulmonary valve replacement (PVR) is performed to reduce right ventricular (RV) volume overload, resulting in improved ventricular function and clinical status. Significant pulmonary regurgitation (PR) after tetralogy of Fallot (TOF) repair could result in RV dysfunction, exercise intolerance, arrhythmia and sudden death. The present study was conducted to investigate the mid-term clinical outcomes of PVR after TOF repair. Between 2001 and 2010, we retrospectively reviewed the outcomes of 131 (89 males and 42 females) PVRs with PR or pulmonary steno-insufficiency after TOF repair. PVR was performed at a mean age of 14.8±6.7 years. The mean interval from total correction of TOF to PVR was 12.5±5.2 years. Surgical indications of PVR were more than moderate PR with/without pulmonary stenosis, right ventricle dilatation, right ventricle dysfunction and reduced exercise capacity. Hancock II (n=58), Carpentier-Edwards Perimount (n=49) and St Jude Biocor (n=35) bioprosthetic valves were used. The mean z-score at implantation was 1.1±0.8. The mean valve size implanted was 25.1±1.5 mm. There was no early or late mortality in this study. RV end-diastolic and end-systolic volume indices (from 111.3±34.7 to 64.6±23.6, P<0.01) (preoperative n=70, postoperative n=17) were markedly decreased PVR during the 13.2±16.1 months follow-up period. Eleven patients (male=10, female=1) required a repeat PVR operation due to prosthetic valve failure. The rate of freedom from reoperation at 10 years was 66.4±4.4%. Implanted valve type (Carpentier-Edwards bovine valve), young age, and large-sized valve implantation (z-score>2.0) were risk factors for a repeat PVR in the univariate analysis. There was no risk factor in the multivariable analysis. PVR reduced the RV volume and improved the RV function within the first postoperative year. The rate of freedom from reoperation during the 10-year follow-up period in our series was acceptable. However, a longer follow-up will be necessary to determine the long-term outcomes of bioprosthetic valves in PVR.