Aortic valve replacement in patients with left ventricular dysfunction: Should surgery be denied

Abstract

Introduction: Tetralogy of Fallot in adults is a surgical challenge owing to the long-standing hypoxic myocardium. Trans-annular patching (TAP) in comparison to an outflow-tract patch (OP) is speculated to cause progressive right ventricular dysfunction due to free pulmonary regurgitation. We present the results of objective assessment of surgical correction in an adult population at mid-tenn follow up.Methods: Ninety patients over the age of twelve years with a Tetralogy of Fallot operated between Jan 1995 and June 2004 at our institution, of which thirty-two patients underwent objective assessment of ventricular function by Tread Mill Testing (TMT) alongwith echocardiography at mid-term follow up, are included in this series. Mean age at surgery was 19.5±6.3 years. The male-to-female ratio was 2.2:1. Twenty-five patients I had undergone an intra-cardiac repair with TAP while seven had the repair with right ventricular OP.Results: Follow up ranged from 6 months to 9 years with a mean of 6.02 years. TMT showed good ventricular function in 31/32 (96.8%) patients with an average of 1 0.3 METS attained along with moderate pulmonary regurgitation on echocardiography. One patient (3.2%) with TAP had poor exercise tolerance with 5 METS achieved on TMT along with severe pulmonary regurgitation on echocardiography. Twenty-six patients were in NYHA class I, six in class II and only one in class III.Conclusions: Complete lntracardiac repair of Tetralogy of Fallot with TAP can be done with acceptable I morbidity. TAP does not appear to be significant risk factor for right ventricular failure at midterm follow up.