Prognostic study in patients with repaired Tetralogy of Fallot (TOF) who underwent pulmonary valve replacement (PVR) for pulmonary regurgitation (PR) at a “senior” age

Abstract

The optimal timing for surgical management of severe PR in patients with repaired TOF is still controversial due to lack of prognostic data. Due to ageing of this population we wanted to analyse the prognostic factors associated with this surgery at a “senior” age. The aim of this study was to define clinical and paraclinical criteria associated with morbidity-mortality of RVP in “senior” patients with repaired TOF. We conducted a single-centre, retrospective study of 48 patients aged 30 years old and above with repaired TOF who underwent RVP at Marseille University Hospital from January 2009 to December 2018. RVP for other congenital cardiopathy or endocarditis and RVP for TOF in patients younger than 30 years old were excluded. The primary outcome was to assess morbidity-mortality with composite criterion including supraventricular arrhythmia, rehospitalization due to any cardiologic cause or death due to any cause. Mean age at PVR was 41 ± 9.8 years old. Mean patient follow-up was 52 months. Twenty-three (48%) patients had the primary outcome. Preoperative signs of late management of patients with repaired TOF complicated of PR, whether left ventricular dysfunction on echocardiography ( P = 0.005), right heart failure ( P = 0.002), syncope or ventricular tachycardia ( P = 0.006), are associated with increased postoperative morbidity-mortality. In multivariate analysis, only elevated right ventricular end-diastolic pressure (RVEDP) was associated with our primary outcome. Preoperative right ventricular volumes on MRI were not associated with our primary endpoint. RVEDP was a risk factor for postoperative morbidity-mortality of PVR. Right heart catheterization could be helpful in deciding the best timing for PVR in “senior” patients with repaired TOF. Our study supports recent research highlighting the limitations of considering right ventricular volumes in MRI as a therapeutic target.