Pulmonary valve replacement in women with repaired tetralogy of Fallot. Contrasting indications compared with men

Abstract

Abstract Background Recent data suggest that in pulmonary regurgitation (PR) after repair of Tetralogy of Fallot (rToF) sex may influence right ventricular (RV) size, mass and function. We hypothesized that women with rToF and PR constitute a patient population with different preoperative clinical characteristics and different postoperative outcomes compared with men. Methods We collected retrospectively demographic data, clinical variables, imaging and functional variables in a cohort of 166 rToF patients (50% males; median age 35; IQR 26–41 years) with at least moderate PR. A transannular patch was used in 73 and 79% of men and women, respectively. The most recent data preceding death and pulmonary valve replacement (PVR) were requested. Variables were compared between men and women. Results Over follow-up, none of the patients died but 35 (42.7%) men and 23 (27.4%) women underwent PVR (p=0.05) at a median age of 32.5 (IQR 23.7–42.7 years). Women are more likely to undergo surgery after developing symptoms, while the criterion for surgery in men was ventricular size. At surgery, women were nearly twice as likely to have class III or IV symptoms preoperatively as men. Although PR fraction was similar between the two groups, indexed ventricular volumes were substantially higher and RV function was lower in males, compared to females. 20% of women had a RVEDVi ≥160ml and a RVESVi ≥80ml, compared with 35 and 32% of men, respectively (p=0.06), and only 6% of woman had an RVEDVi >180ml, compared with 18% of men (p=0.01). Fibrosis detected on late gadolinium was observed in 100% of men but only in 20% of women (p=0.009). Conclusions Under comparable loading conditions, a striking difference was noted in the condition leading to the surgical indication. These results suggest that the generalization of the RV dimension surgical criteria results in criteria almost never reached by women. Recommendations need more focus on sex differences. Funding Acknowledgement Type of funding sources: None.