Reintervenciones quirúrgicas en adultos con situación Fallot: una población emergente

Abstract

Introduction-objectivesFallot has excellent post-surgical survival, although it has late morbidity including re-operations. Of all the Fallot patients currently followed-up in our Adult Congenital Heart Disease (ACHD) Unit, 26% needed re-operation. An analysis is performed on these late re-operations and the outcomes achieved. MethodsRetrospective study (1991-2014): 90 re-operations in 84 Fallot patients previously operated in the ACHD unit. ResultsMean age: 33±10 years, 59% males, 2±1 previous surgeries/patient. Preoperative functional NYHA class I-II: 46.4%, III-IV: 53.6%; arrhythmia: 45%. Main surgical indications: pulmonary insufficiency and/or stenosis (76.7%), aortic insufficiency (11.1%), residual septal defect (7.8%), and tricuspid insufficiency (4.4%). Re-operations were performed with extracorporeal circulation, and without clamping aorta in 34%. Surgical techniques employed: 81.1% received pulmonary surgery (68.9% bio-prosthesis), 50% septal defect closure, 25.5% tricuspid, and 18.9% aortic valve surgery. Hospital mortality: 4.4%. Mean follow-up: 5.9±6.2 years. During this period 3 patients died, 12 received new surgery, and there were 9 percutaneous interventions. Survival at 3 and 11 years was 96% and 90% respectively. Currently, 92.2% patients are in functional class I-II, and 82.3% in sinus rhythm. Pre- and post-operative cardiovascular magnetic resonance studies show that pulmonary bioprosthesis significatively improves pulmonary regurgitation and reduces right ventricle function (P=.001), without changing right ventricle function. ConclusionsMain indications for reintervention in Fallot in the ACHD Unit are pulmonary valve dysfunction requiring a bioprosthesis implant. Good survival was achieved in these re-operations, improving patients symptoms and reducing right ventricle volumes.