Individualised prediction of pulmonary homograft durability in tetralogy of Fallot.
Heart
; 101(21): 1717-23, 2015 Nov.
Article
en En
| MEDLINE
| ID: mdl-26175476
ABSTRACT
BACKGROUND:
In patients with repaired tetralogy of Fallot (rTOF), multiple reoperations or percutaneous interventions after pulmonary valve replacement (PVR) may be necessary due to limited homograft durability. However, data to guide individualised prediction of homograft durability remain scarce. The aim of this study was to provide risk models for RV to pulmonary artery homograft durability.METHODS:
This retrospective multicentre study included consecutive patients with rTOF who had undergone PVR at an age of >12â years. Homograft dysfunction was defined as at least moderate pulmonary regurgitation (PR) or pulmonary stenosis (PS) (pressure gradient ≥36â mmâ Hg) as assessed by echocardiography. Reintervention was defined as percutaneous intervention or redo-PVR.RESULTS:
A total of 153 patients with rTOF were included (62% male, mean age at PVR 31±11â years, pulmonary homograft 96%, follow-up 9.6â years (IQR 5.9, 13.3)). Average freedom from homograft dysfunction and reintervention after 10â years was 74% and 89%, respectively. In multivariable Cox proportional hazards analysis, postoperative PS ≥20â mmâ Hg (HR 6.52, 95% CI 3.09 to 13.7), postoperative PR ≥ grade 1 (HR 3.13, 95% CI 1.45 to 6.74) and age at PVR <18â years (HR 3.52, 95% CI 1.64 to 7.53) were independently predictive for homograft dysfunction. In patients without any risk factor, 10-year freedom from homograft dysfunction and reintervention was excellent (91% and 96%, respectively) in contrast to patients with ≥2 risk factors (25% and 73%, respectively).CONCLUSIONS:
Individualised prediction of homograft durability in patients with rTOF can be guided by early postoperative echocardiography. In adult patients without early postoperative PS or PR, homograft dysfunction and reintervention are unlikely to occur within 10â years, and follow-up may be less stringent.
Texto completo:
1
Colección:
01-internacional
Banco de datos:
MEDLINE
Asunto principal:
Complicaciones Posoperatorias
/
Arteria Pulmonar
/
Válvula Pulmonar
/
Procedimientos Quirúrgicos Cardiovasculares
/
Tetralogía de Fallot
/
Disfunción Ventricular Derecha
Tipo de estudio:
Diagnostic_studies
/
Etiology_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Límite:
Adult
/
Female
/
Humans
/
Male
País/Región como asunto:
Europa
Idioma:
En
Revista:
Heart
Asunto de la revista:
CARDIOLOGIA
Año:
2015
Tipo del documento:
Article
País de afiliación:
Países Bajos