Younger age and valve oversizing are predictors of structural valve deterioration after pulmonary valve replacement in patients with tetralogy of Fallot

Abstract

We sought to identify predictors of structural valve deterioration after pulmonary valve replacement in patients with tetralogy of Fallot. A retrospective review of 227 patients with tetralogy of Fallot who underwent stented bioprosthetic pulmonary valve replacement at Children's Hospital Boston between 1994 and 2009 was performed. Patient and valve characteristics were assessed as potential predictors of structural valve deterioration by using univariate and multivariable analysis. Freedom from pulmonary valve reintervention and structural valve deterioration were determined by using Kaplan-Meier analysis. Two hundred twenty-nine pulmonary valve replacement operations were performed, with no early mortalities. Freedom from reintervention and structural valve deterioration were 94% (95% confidence interval, 87%-100%) and 74% (95% confidence interval, 63%-85%) at 5 years, respectively, and median time to reintervention was 6.4 years (range, 2-10.1 years). Younger age and higher indexed valve internal diameter were predictors of reduced time to structural valve deterioration. Among patients aged less than 20 years at the time of pulmonary valve replacement, indexed valve internal diameter was a significant predictor of increased risk of structural valve deterioration. Valve manufacturer was not a significant predictor of structural valve deterioration. Younger age at the time of pulmonary valve replacement and valve oversizing in patients less than 20 years of age at the time of pulmonary valve replacement were significant predictors of structural valve deterioration and could potentially affect the timing of pulmonary valve replacement and the extent of valve oversizing in small children. No statistically significant difference in valve performance was seen between bioprosthetic valve types at short-term follow-up.