Outcome of pulmonary valve replacements in adults after tetralogy repair: A multi-institutional study

Thomas P. Graham, Yvonne Bernard, Patrick Arbogast, Sravan Thapa, Frank Cetta, John Child, Reema Chugh, William Davidson, Roger Hurwitz, Joseph Kay, Stephen Sanders, Maria Schaufelberger

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

Objective. The purpose of this study was to assess the outcome of pulmonary valve replacement (PVR) in adults with moderate/severe pulmonary regurgitation after tetralogy repair, with particular emphasis on patient outcome, durability of valve repair, and improvement in symptomatology. Design/Setting/Patients. The project committee of the International Society of Congenital Heart Disease undertook a retrospective multi-institutional analysis of PVR. Seven centers participated in submitting data on 93 patients >18 years of age who had the operation performed and follow-up obtained. The average age of PVR was 26± years (median 27 years). Time of follow-up after replacement was 3 years (range 4 days-28 years). Outcomes/Measures/Results. Kaplan-Meier estimates of durability of PVR showed approximately 50% replacement at 11 years. There were two deaths at 6 and 12 months after valve replacement. Right ventricular (RV) size estimated by echocardiography from pre- to postoperative studies decreased in 81% (P < 0.001 testing for equal proportions), but RV systolic function increased in only 36% (P = 0.09). Ability index improved in 59% (P < 0.001) and clinical heart failure status improved in 57% with this problem before PVR. PVR did not improve arrhythmia status in a small group of patients. Conclusions. PVR is associated with low mortality, decrease in RV size and improvement in ability index, and uncertain effects on RV systolic function. Average valve durability was approximately 11 years. Criteria for PVR that will preserve RV function are not clearly identified, and management of these patients remains a difficult enterprise.

Original languageEnglish (US)
Pages (from-to)162-167
Number of pages6
JournalCongenital Heart Disease
Volume3
Issue number3
DOIs
StatePublished - May 1 2008

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Pulmonary Valve
Right Ventricular Function
Pulmonary Valve Insufficiency
Kaplan-Meier Estimate
Echocardiography
Cardiac Arrhythmias
Heart Diseases
Heart Failure
Outcome Assessment (Health Care)
Mortality

All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health
  • Surgery
  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Graham, T. P., Bernard, Y., Arbogast, P., Thapa, S., Cetta, F., Child, J., ... Schaufelberger, M. (2008). Outcome of pulmonary valve replacements in adults after tetralogy repair: A multi-institutional study. Congenital Heart Disease, 3(3), 162-167. https://doi.org/10.1111/j.1747-0803.2008.00189.x
Graham, Thomas P. ; Bernard, Yvonne ; Arbogast, Patrick ; Thapa, Sravan ; Cetta, Frank ; Child, John ; Chugh, Reema ; Davidson, William ; Hurwitz, Roger ; Kay, Joseph ; Sanders, Stephen ; Schaufelberger, Maria. / Outcome of pulmonary valve replacements in adults after tetralogy repair : A multi-institutional study. In: Congenital Heart Disease. 2008 ; Vol. 3, No. 3. pp. 162-167.
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abstract = "Objective. The purpose of this study was to assess the outcome of pulmonary valve replacement (PVR) in adults with moderate/severe pulmonary regurgitation after tetralogy repair, with particular emphasis on patient outcome, durability of valve repair, and improvement in symptomatology. Design/Setting/Patients. The project committee of the International Society of Congenital Heart Disease undertook a retrospective multi-institutional analysis of PVR. Seven centers participated in submitting data on 93 patients >18 years of age who had the operation performed and follow-up obtained. The average age of PVR was 26± years (median 27 years). Time of follow-up after replacement was 3 years (range 4 days-28 years). Outcomes/Measures/Results. Kaplan-Meier estimates of durability of PVR showed approximately 50{\%} replacement at 11 years. There were two deaths at 6 and 12 months after valve replacement. Right ventricular (RV) size estimated by echocardiography from pre- to postoperative studies decreased in 81{\%} (P < 0.001 testing for equal proportions), but RV systolic function increased in only 36{\%} (P = 0.09). Ability index improved in 59{\%} (P < 0.001) and clinical heart failure status improved in 57{\%} with this problem before PVR. PVR did not improve arrhythmia status in a small group of patients. Conclusions. PVR is associated with low mortality, decrease in RV size and improvement in ability index, and uncertain effects on RV systolic function. Average valve durability was approximately 11 years. Criteria for PVR that will preserve RV function are not clearly identified, and management of these patients remains a difficult enterprise.",
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Graham, TP, Bernard, Y, Arbogast, P, Thapa, S, Cetta, F, Child, J, Chugh, R, Davidson, W, Hurwitz, R, Kay, J, Sanders, S & Schaufelberger, M 2008, 'Outcome of pulmonary valve replacements in adults after tetralogy repair: A multi-institutional study', Congenital Heart Disease, vol. 3, no. 3, pp. 162-167. https://doi.org/10.1111/j.1747-0803.2008.00189.x

Outcome of pulmonary valve replacements in adults after tetralogy repair : A multi-institutional study. / Graham, Thomas P.; Bernard, Yvonne; Arbogast, Patrick; Thapa, Sravan; Cetta, Frank; Child, John; Chugh, Reema; Davidson, William; Hurwitz, Roger; Kay, Joseph; Sanders, Stephen; Schaufelberger, Maria.

In: Congenital Heart Disease, Vol. 3, No. 3, 01.05.2008, p. 162-167.

Research output: Contribution to journalArticle

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T1 - Outcome of pulmonary valve replacements in adults after tetralogy repair

T2 - A multi-institutional study

AU - Graham, Thomas P.

AU - Bernard, Yvonne

AU - Arbogast, Patrick

AU - Thapa, Sravan

AU - Cetta, Frank

AU - Child, John

AU - Chugh, Reema

AU - Davidson, William

AU - Hurwitz, Roger

AU - Kay, Joseph

AU - Sanders, Stephen

AU - Schaufelberger, Maria

PY - 2008/5/1

Y1 - 2008/5/1

N2 - Objective. The purpose of this study was to assess the outcome of pulmonary valve replacement (PVR) in adults with moderate/severe pulmonary regurgitation after tetralogy repair, with particular emphasis on patient outcome, durability of valve repair, and improvement in symptomatology. Design/Setting/Patients. The project committee of the International Society of Congenital Heart Disease undertook a retrospective multi-institutional analysis of PVR. Seven centers participated in submitting data on 93 patients >18 years of age who had the operation performed and follow-up obtained. The average age of PVR was 26± years (median 27 years). Time of follow-up after replacement was 3 years (range 4 days-28 years). Outcomes/Measures/Results. Kaplan-Meier estimates of durability of PVR showed approximately 50% replacement at 11 years. There were two deaths at 6 and 12 months after valve replacement. Right ventricular (RV) size estimated by echocardiography from pre- to postoperative studies decreased in 81% (P < 0.001 testing for equal proportions), but RV systolic function increased in only 36% (P = 0.09). Ability index improved in 59% (P < 0.001) and clinical heart failure status improved in 57% with this problem before PVR. PVR did not improve arrhythmia status in a small group of patients. Conclusions. PVR is associated with low mortality, decrease in RV size and improvement in ability index, and uncertain effects on RV systolic function. Average valve durability was approximately 11 years. Criteria for PVR that will preserve RV function are not clearly identified, and management of these patients remains a difficult enterprise.

AB - Objective. The purpose of this study was to assess the outcome of pulmonary valve replacement (PVR) in adults with moderate/severe pulmonary regurgitation after tetralogy repair, with particular emphasis on patient outcome, durability of valve repair, and improvement in symptomatology. Design/Setting/Patients. The project committee of the International Society of Congenital Heart Disease undertook a retrospective multi-institutional analysis of PVR. Seven centers participated in submitting data on 93 patients >18 years of age who had the operation performed and follow-up obtained. The average age of PVR was 26± years (median 27 years). Time of follow-up after replacement was 3 years (range 4 days-28 years). Outcomes/Measures/Results. Kaplan-Meier estimates of durability of PVR showed approximately 50% replacement at 11 years. There were two deaths at 6 and 12 months after valve replacement. Right ventricular (RV) size estimated by echocardiography from pre- to postoperative studies decreased in 81% (P < 0.001 testing for equal proportions), but RV systolic function increased in only 36% (P = 0.09). Ability index improved in 59% (P < 0.001) and clinical heart failure status improved in 57% with this problem before PVR. PVR did not improve arrhythmia status in a small group of patients. Conclusions. PVR is associated with low mortality, decrease in RV size and improvement in ability index, and uncertain effects on RV systolic function. Average valve durability was approximately 11 years. Criteria for PVR that will preserve RV function are not clearly identified, and management of these patients remains a difficult enterprise.

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