医学
法洛四联症
四分位间距
心室流出道
置信区间
肺动脉瓣
肺动脉瓣关闭不全
心脏病学
外科
内科学
回顾性队列研究
肺动脉
心脏病
肺返流
作者
Shuta Ishigami,Xin Tao Ye,Edward Buratto,Yaroslav Ivanov,Kuntal Roy Chowdhuri,Nick Fulkoski,Terry Robertson,Ben Davies,Christian P. Brizard,Igor E. Konstantinov
标识
DOI:10.1016/j.jtcvs.2023.04.015
摘要
Abstract
Objective
This study evaluates the long-term results of tetralogy of Fallot repair and assesses the risk factors for adverse outcomes. Methods
This retrospective study included 960 patients who underwent transatrial transpulmonary tetralogy of Fallot repair between 1990 and 2020. Results
A transannular patch was placed in 722 patients, and pulmonary valve preservation was achieved in 233 patients. The median age at tetralogy of Fallot repair was 9.4 (interquartile range, 6.2-14.2) months. The median follow-up duration was 10.6 (interquartile range, 5.4-16.3) years. There were 8 early deaths (0.8%) and 20 late deaths (2.1%). Genetic syndrome and pulmonary valve annulus Z score less than −3 were risk factors for mortality. The survival was 97.7% (95% confidence interval, 96.4-98.5) and 94.5% (95% confidence interval, 90.9-96.7) at 10 and 30 years, respectively. Freedom from any reoperation was 86.4% (95% confidence interval, 83.6-88.7) and 65.4% (95% confidence interval, 59.8-70.4) at 10 and 20 years, respectively. Postoperative right ventricular outflow tract peak gradient of 25 mm Hg or greater correlated with reoperation. Propensity score–matched analysis demonstrated that freedom from pulmonary valve replacement at 15 years was higher in the pulmonary valve preservation group compared with the transannular patch group (98.2% vs 78.4%, P = .004). Freedom from reoperation for right ventricular outflow tract obstruction at 15 years was lower in the pulmonary valve preservation group compared with the transannular patch group (P = .006). Conclusions
The long-term outcomes of tetralogy of Fallot repair are excellent. A postoperative right ventricular outflow tract peak gradient less than 25 mm Hg appears to be optimal to prevent reoperation. If the pulmonary valve size is suitable, pulmonary valve preservation reduces the risk of pulmonary valve replacement, yet increases the reoperation rate for right ventricular outflow tract obstruction.
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