Clinical Outcomes of Surgical Pulmonary Valve Replacement After Repair of Tetralogy of Fallot and Potential Prognostic Value of Preoperative Cardiopulmonary Exercise Testing
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- Sonya V. Babu-Narayan
- From the Royal Brompton and Harefield NHS Foundation Trust, London, UK (S.V.B.-N., G.-P.D., R.R.G., A.J.B., T.K., W.L., D.J.P., H.U., B.S., M.A.G., D.F.S.); and National Heart and Lung Institute, Imperial College London and NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and Imperial College London, London, UK (S.V.B.-N., W.L., D.J.P., M.A.G., D.F.S.).
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- Gerhard-Paul Diller
- From the Royal Brompton and Harefield NHS Foundation Trust, London, UK (S.V.B.-N., G.-P.D., R.R.G., A.J.B., T.K., W.L., D.J.P., H.U., B.S., M.A.G., D.F.S.); and National Heart and Lung Institute, Imperial College London and NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and Imperial College London, London, UK (S.V.B.-N., W.L., D.J.P., M.A.G., D.F.S.).
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- Radu R. Gheta
- From the Royal Brompton and Harefield NHS Foundation Trust, London, UK (S.V.B.-N., G.-P.D., R.R.G., A.J.B., T.K., W.L., D.J.P., H.U., B.S., M.A.G., D.F.S.); and National Heart and Lung Institute, Imperial College London and NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and Imperial College London, London, UK (S.V.B.-N., W.L., D.J.P., M.A.G., D.F.S.).
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- Anthony J. Bastin
- From the Royal Brompton and Harefield NHS Foundation Trust, London, UK (S.V.B.-N., G.-P.D., R.R.G., A.J.B., T.K., W.L., D.J.P., H.U., B.S., M.A.G., D.F.S.); and National Heart and Lung Institute, Imperial College London and NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and Imperial College London, London, UK (S.V.B.-N., W.L., D.J.P., M.A.G., D.F.S.).
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- Theodoros Karonis
- From the Royal Brompton and Harefield NHS Foundation Trust, London, UK (S.V.B.-N., G.-P.D., R.R.G., A.J.B., T.K., W.L., D.J.P., H.U., B.S., M.A.G., D.F.S.); and National Heart and Lung Institute, Imperial College London and NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and Imperial College London, London, UK (S.V.B.-N., W.L., D.J.P., M.A.G., D.F.S.).
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- Wei Li
- From the Royal Brompton and Harefield NHS Foundation Trust, London, UK (S.V.B.-N., G.-P.D., R.R.G., A.J.B., T.K., W.L., D.J.P., H.U., B.S., M.A.G., D.F.S.); and National Heart and Lung Institute, Imperial College London and NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and Imperial College London, London, UK (S.V.B.-N., W.L., D.J.P., M.A.G., D.F.S.).
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- Dudley J. Pennell
- From the Royal Brompton and Harefield NHS Foundation Trust, London, UK (S.V.B.-N., G.-P.D., R.R.G., A.J.B., T.K., W.L., D.J.P., H.U., B.S., M.A.G., D.F.S.); and National Heart and Lung Institute, Imperial College London and NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and Imperial College London, London, UK (S.V.B.-N., W.L., D.J.P., M.A.G., D.F.S.).
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- Hideki Uemura
- From the Royal Brompton and Harefield NHS Foundation Trust, London, UK (S.V.B.-N., G.-P.D., R.R.G., A.J.B., T.K., W.L., D.J.P., H.U., B.S., M.A.G., D.F.S.); and National Heart and Lung Institute, Imperial College London and NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and Imperial College London, London, UK (S.V.B.-N., W.L., D.J.P., M.A.G., D.F.S.).
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- Babulal Sethia
- From the Royal Brompton and Harefield NHS Foundation Trust, London, UK (S.V.B.-N., G.-P.D., R.R.G., A.J.B., T.K., W.L., D.J.P., H.U., B.S., M.A.G., D.F.S.); and National Heart and Lung Institute, Imperial College London and NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and Imperial College London, London, UK (S.V.B.-N., W.L., D.J.P., M.A.G., D.F.S.).
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- Michael A. Gatzoulis
- From the Royal Brompton and Harefield NHS Foundation Trust, London, UK (S.V.B.-N., G.-P.D., R.R.G., A.J.B., T.K., W.L., D.J.P., H.U., B.S., M.A.G., D.F.S.); and National Heart and Lung Institute, Imperial College London and NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and Imperial College London, London, UK (S.V.B.-N., W.L., D.J.P., M.A.G., D.F.S.).
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- Darryl F. Shore
- From the Royal Brompton and Harefield NHS Foundation Trust, London, UK (S.V.B.-N., G.-P.D., R.R.G., A.J.B., T.K., W.L., D.J.P., H.U., B.S., M.A.G., D.F.S.); and National Heart and Lung Institute, Imperial College London and NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and Imperial College London, London, UK (S.V.B.-N., W.L., D.J.P., M.A.G., D.F.S.).
説明
<jats:sec> <jats:title>Background—</jats:title> <jats:p>Indications for surgical pulmonary valve replacement (PVR) after repair of tetralogy of Fallot have recently been broadened to include asymptomatic patients.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods and Results—</jats:title> <jats:p> The outcomes of PVR in adults after repair of tetralogy of Fallot at a single tertiary center were retrospectively studied. Preoperative cardiopulmonary exercise testing was included. Mortality was the primary outcome measure. In total, 221 PVRs were performed in 220 patients (130 male patients; median age, 32 years; range, 16–64 years). Homografts were used in 117 patients, xenografts in 103 patients, and a mechanical valve in 1 patient. Early (30-day) mortality was 2%. Overall survival was 97% at 1 year, 96% at 3 years, and 92% at 10 years. Survival after PVR in the later era (2005–2010; n=156) was significantly better compared with survival in the earlier era (1993–2004; n=65; 99% versus 94% at 1 year and 98% versus 92% at 3 years, respectively; <jats:italic>P</jats:italic> =0.019). Earlier era patients were more symptomatic preoperatively ( <jats:italic>P</jats:italic> =0.036) with a lower preoperative peak oxygen consumption (peak <jats:inline-graphic xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="18eq01.jpeg"/> <jats:sc>o</jats:sc> <jats:sub>2</jats:sub> ; <jats:italic>P</jats:italic> <0.001). Freedom from redo surgical or transcatheter PVR was 98% at 5 years and 96% at 10 years for the whole cohort. Peak <jats:inline-graphic xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="18eq02.jpeg"/> <jats:sc>o</jats:sc> <jats:sub>2</jats:sub> , E/CO2 slope (ratio of minute ventilation to carbon dioxide production), and heart rate reserve during cardiopulmonary exercise testing predicted risk of early mortality when analyzed with logistic regression analysis; peak <jats:inline-graphic xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="18eq03.jpeg"/> <jats:sc>o</jats:sc> <jats:sub>2</jats:sub> emerged as the strongest predictor on multivariable analysis (odds ratio, 0.65 per 1 mL·kg <jats:sup>−1</jats:sup> ·min <jats:sup>−1</jats:sup> ; <jats:italic>P</jats:italic> =0.041). </jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions—</jats:title> <jats:p>PVR after repair of tetralogy of Fallot has a low and improving mortality, with a low need for reintervention. Preoperative cardiopulmonary exercise testing predicts surgical outcome and should therefore be included in the routine assessment of these patients.</jats:p> </jats:sec>
収録刊行物
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- Circulation
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Circulation 129 (1), 18-27, 2014-01-07
Ovid Technologies (Wolters Kluwer Health)