Long-term follow-up of homograft function after pulmonary valve replacement in patients with tetralogy of Fallot

Abstract

While 47% of the patients in our study were free from homograft dysfunction at 10 years after PVR, event-free survival after PVR remained fairly good (78%). Significant residual lesions directly after surgery influenced event-free survival. A smaller diameter of the pulmonary homograft and severe pre-surgical PR were related to early homograft dysfunction after surgery.

Clinical Outcomes of Surgical Pulmonary Valve Replacement After Repair of Tetralogy of Fallot and Potential Prognostic Value of Preoperative Cardiopulmonary Exercise Testing

“…When the deleterious effects of pulmonary regurgitation were more fully appreciated circa 2000, asymptomatic patients with pulmonary regurgitation were considered for PVR, including patients with lower or declining peak V . Our data confirm that surgical PVR is a low-risk operation, 10,14,[17][18][19][20][21][22][23][24][25][26][27][28][29][30] despite the fact that symptomatic patients and patients with multiple previous sternotomies were included in our report. All 5 patients who died early, however, died of right heart failure, suggesting that despite our modified, proactive approach for PVR, we still operate too late in some cases.…”

Cardiovascular MR Imaging after Surgical Correction of Tetralogy of Fallot: Approach Based on Understanding of Surgical Procedures

“…Chronic pulmonary regurgitation can result in right ventricular dilatation, arrhythmias, and contractile dysfunction. Pulmonary valve replacement may be necessary to prevent or resolve these complications (3,4,6,12,18).…”

Invited Commentary

“…The insertion of a competent valve is an important step in the course of treating these patients to restore or preserve the function of their steadily dilating right ventricle and to prevent the development of ominous ventricular arrhythmias [3, 4]. The disadvantages of valvular prostheses are well known, the most important ones being the need for iterative replacement in the usual treatment of tissue valves and bacterial endocarditis [5][6][7]. The recycling of the native, viable pulmonary valve could circumvent all these problems and bring a long-term solution to these patients.…”