Right ventricular outflow tract reconstruction with an allograft conduit in patients after tetralogy of Fallot correction: long-term follow-up

Ann Thorac Surg. 2011 Jul;92(1):161-6. doi: 10.1016/j.athoracsur.2011.02.036. Epub 2011 May 18.

Abstract

Background: In tetralogy of Fallot (TOF) pulmonary regurgitation is a frequent complication after initial repair. The objective of the present study was to describe the long-term experience with the use of allograft conduits for right ventricular outflow tract (RVOT) reconstruction after correction of TOF in our institution.

Methods: Between 1987 and 2009, 133 allografts were implanted in 126 patients (mean age, 27.8 years). The mean time from initial TOF repair to allograft implantation was 20.8±8.8 years. Kaplan-Meier analyses were done for patient survival, freedom from allograft replacement and freedom from any cardiovascular event.

Results: Hospital mortality was 1.5% (2 patients). Mean follow-up was 8.1 years. Ten other patients died during late follow-up, in 8 patients the cause was heart failure. Patient survival was 95% at 5 years, 91% at 10 years, and 80% at 15 years. Male sex, older patient age at the time of operation, and the use of preoperative diuretics were associated with increased risk of mortality during follow-up. Freedom from allograft replacement was 83% at 10 years and 70% at 15 years. Freedom from any valve-related event was 80% at 10 years and 67% at 15 years.

Conclusions: Right ventricular outflow tract reconstruction after previous TOF repair can be performed with low risk and a low reintervention rate. Allograft conduits function satisfactorily in the pulmonary position at longer-term follow-up. Functional status after allograft implantation in patients with a previous correction of TOF remains good. There is concern about the long-term survival and the occurrence of heart failure.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Age Factors
  • Cardiac Surgical Procedures / methods
  • Child
  • Child, Preschool
  • Cohort Studies
  • Combined Modality Therapy
  • Confidence Intervals
  • Education, Medical, Continuing
  • Female
  • Follow-Up Studies
  • Heart Ventricles / physiopathology
  • Heart Ventricles / surgery*
  • Humans
  • Infant
  • Kaplan-Meier Estimate
  • Male
  • Pulmonary Valve / surgery
  • Pulmonary Valve / transplantation*
  • Reconstructive Surgical Procedures / methods*
  • Reconstructive Surgical Procedures / mortality
  • Retrospective Studies
  • Risk Assessment
  • Sex Factors
  • Survival Rate
  • Tetralogy of Fallot / diagnosis
  • Tetralogy of Fallot / mortality
  • Tetralogy of Fallot / surgery*
  • Tissue Donors
  • Transplantation, Homologous
  • Treatment Outcome
  • Ventricular Outflow Obstruction / prevention & control*
  • Young Adult