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Title: | Low risk of pulmonary valve implantation after a policy of transatrial repair of tetralogy of fallot delayed beyond the neonatal period: The Melbourne experience over 25 years. | Authors: | D'Udekem Y.;Ramsay J.M.;Wheaton G.R.;Cheung M.H.;Brizard C.P.;Grigg L.;Hope S. ;Weintraub R.G.;Konstantinov I.E.;Rolley G.J.;Galati J.C. | Institution: | (D'Udekem, Rolley, Konstantinov, Brizard) Department of Cardiac Surgery, Royal Children's Hospital, Flemington Road, Melbourne, VIC 3052, Australia (D'Udekem, Konstantinov, Brizard) Department of Pediatrics, University of Melbourne, Murdoch Children's Institute, Melbourne, VIC, Australia (Galati) Department of Clinical Epidemiology, Biostatistics Unit, Murdoch Children's Research Institute, Melbourne, VIC, Australia (Galati) Department of Mathematics and Statistics, La Trobe University, Melbourne, VIC, Australia (Weintraub, Cheung) Department of Cardiology, Royal Children's Hospital, Melbourne, VIC, Australia (Grigg) Department of Cardiology, Royal Melbourne Hospital, Melbourne, VIC, Australia (Ramsay) Department of Cardiology, Princess Margaret Hospital for Children, Perth, WA, Australia (Wheaton) Department of Cardiology, Women's and Children's Hospital, Adelaide, SA, Australia (Hope) Department of Cardiology, Monash Medical Centre, Clayton, Melbourne, VIC, Australia | Issue Date: | 24-Feb-2015 | Copyright year: | 2014 | Publisher: | Elsevier USA | Place of publication: | United States | Publication information: | Journal of the American College of Cardiology. 63 (6) (pp 563-568), 2014. Date of Publication: 18 Feb 2014. | Journal: | Journal of the American College of Cardiology | Abstract: | Objectives: The study sought to evaluate the late outcomes of a policy of transatrial repair delayed beyond the neonatal period. Background(s): Long-term outcomes of transatrial repair of tetralogy of Fallot are unknown. Method(s): The records of 675 consecutive patients undergoing a transatrial repair of tetralogy of Fallot between 1980 and 2005 were reviewed, their follow-up updated and survival confirmed from national death registries. One-third (220 of 675) had undergone previous palliation. Median age at repair was 2 years in the first 8 years, and 1 year from 1988 onward. A transannular incision was performed in 75% of cases and autologous pericardium was the material used to patch this incision in 92% of cases. Result(s): There were 7 hospital deaths (1%). Eight patients died during follow-up (2 sudden unexpected and 6 noncardiac deaths). Mean follow-up was 11.7 +/- 6.3 years. Twenty-five years' survival was 97% (95% confidence interval [CI]: 95% to 98%). Twenty-five years' freedom from implantation of a valved conduit was 84.6% (95% CI: 77.8% to 89.5%). By multivariable analysis, prior palliation and younger age at repair were predictive of implantation of a valved conduit (hazard ratio: 2.4, 95% CI: 1.3 to 4.6, p = 0.008; hazard ratio: 0.70, 95% CI: 0.50 to 0.96, p = 0.03, respectively). Conclusion(s): During long-term follow-up, transatrial repair of tetralogy of Fallot was associated with a minimal risk of sudden death and low rate of reintervention for right ventricular dilation and residual outflow tract obstruction.Copyright © 2014 by the American College of Cardiology Foundation. | DOI: | http://monash.idm.oclc.org/login?url=http://dx.doi.org/10.1016/j.jacc.2013.10.011 | PubMed URL: | 24513776 [http://www.ncbi.nlm.nih.gov/pubmed/?term=24513776] | ISSN: | 0735-1097 | URI: | https://repository.monashhealth.org/monashhealthjspui/handle/1/41967 | Type: | Article | Subjects: | pulmonary artery stenosis/co [Complication] pulmonary valve insufficiency/co [Complication] *pulmonary valve replacement retrospective study sudden death survival rate *therapy delay treatment outcome tricuspid valve repair valved conduit *newborn period age aorta valve regurgitation/co [Complication] article cardiovascular mortality cardiovascular risk cause of death cerebrovascular accident/co [Complication] child *clinical protocol controlled study *Fallot tetralogy/su [Surgery] female heart right ventricle outflow tract obstruction/co [Complication] heart ventricle septum defect/co [Complication] human major clinical study male pacemaker implantation palliative therapy pericardial patch pneumonia/co [Complication] postoperative complication/co [Complication] pulmonary artery catheterization *Fallot tetralogy / *surgery female heart right ventricle outflow tract obstruction / complication heart ventricle septum defect / complication human major clinical study male *newborn period pacemaker implantation palliative therapy pericardial patch pneumonia / complication postoperative complication / complication pulmonary artery catheterization pulmonary artery stenosis / complication pulmonary valve insufficiency / complication *pulmonary valve replacement retrospective study sudden death survival rate *therapy delay aorta valve regurgitation / complication tricuspid valve repair valved conduit age treatment outcome Article cardiovascular mortality cardiovascular risk cause of death cerebrovascular accident / complication child *clinical protocol controlled study |
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