Pulmonary valve and right ventricular outflow tract surgery in adults: 23-year experience

Abstract

A b s t r a c tBackground: Surgery of the pulmonary valve, right ventricular outflow tract, and pulmonary artery falls under the domain of paediatric cardiac surgery. However, 97 adult patients underwent such operations in our institution from 1993 to 2016. Aim:This study aims to analyse preoperative risk factors, intraoperative data, postoperative outcomes, and long-term survival to identify the potential predictors of mortality and high-risk patients. Methods:We divided our patient cohort into three groups in accordance with surgical indications: 17 patients with pulmonary valve endocarditis (group A), 70 patients with congenital defects involving the pulmonary valve (group B), and 10 patients who underwent pulmonary valve surgery for other indications, such as tumour or other acquired valvular disease (group C). Results:Gender distribution was comparable in all the three groups, with about 40% of the total number of patients being female. The mean age was 35.9 ± 15.7 years. Sixty (61.9%) patients had a history of cardiac surgery. Various concomitant cardiac surgical procedures were necessary in 49 (50.5%) cases. There were two (11.8%) in-hospital deaths in group A, two (2.9%) in group B, and none in group C. Within the mean follow-up time of 6.6 ±7.2 years, three (17.7%) patients in group A, two (2.9%) in group B, and four (40%) in group C died. Conclusions:Adult patients with pulmonary valve disease are often previously heart-operated and often need concomitant procedures. The operative risk in patients with pulmonary valve endocarditis is high. Surgery of congenital defects of the pulmonary valve is safe and can be performed with excellent outcomes.

Pulmonary Regurgitation- Is the Future Percutaneous or Surgical?

“…No company has aggressively developed a surgical pulmonary valve with improved longevity or performance; valve technology is still borrowed from aortic tissue valves which have, again reached a hard stop in their development. Stented tissue xenograft valves, cadaveric homografts and xenograft conduits remain the mainstay of treatment ( 4 , 5 ). Operative techniques continue to be refined in general terms without any huge advances; in particular, cardiopulmonary bypass technology has not seen any major forward steps in over 10 years ( 6 ).…”

Ablation of atrial tachyarrhythmias late after surgical correction of tetralogy of Fallot: long-term follow-up

“…Approximately 25% of adult hospital admissions due to congenital heart disease are associated with arrhythmia [2]. Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart condition with an incidence of 1 in 2500; in patients with this defect, the presence of atrial arrhythmia is associated with higher mortality [3][4][5]. After the surgical correction of congenital or acquired heart disease, surgical scars and natural conduction obstacles form narrow pathways capable of supporting an intraatrial reentrant tachycardia (IART) [6,7].…”