초록접수 현황
| 14F-246 | 구연 발표 |
Factors that Affect Durability of Bioprosthetic Valve in Pulmonary Position in the Patients with Tetralogy of Fallot: Age? Valve Size?
곽재건¹, 이철², 이미나¹, 이창하¹
세종병원 흉부외과¹, 가톨릭대학교 서울성모병원 흉부외과학교실²
Background : Early degeneration of the bioprosthetic valves in the pulmonary portion is well known in young patients with pulmonary regurgitation (PR) after correction of tetralogy of Fallot (TOF). However, the durability of bioprosthetic valves in grown-up patients is not clear. We reviewed our surgical outcomes of pulmonary valve replacement (PVR) with tissue valves in the pulmonary portion in patients after total correction of TOF, especially with respect to the patient age and valve size.
Methods : We retrospectively reviewed 122 cases of PVR with commercial tissue valves (bovine pericardial and porcine valve), which was performed between January 1998 and February 2014, in the patients after total correction of TOF. We excluded the patients who underwent PVR with stentless porcine valves, which showed significantly much worse outcomes than PVR with the other types of bioprosthetic valves. We defined valvular dysfunction as at least a moderate amount of PR or a peak pressure gradient ≥ 40 mmHg on the latest echocardiography.
Results : There were 2 early deaths and no late deaths. Follow-up duration (from the operation to the last echocardiography) was 57.2 ± 38.5 months, and 90.0 % (108 out of 120 patients) of patients were followed up. The mean age at PVR was 19.3 ± 9.1 years. The number of the patients younger than 19 years was 66 (54.1 %). The mean valve size was 24.8 ± 1.7 mm (range, 19 ~ 27 mm), and the number of the valves less than 25 mm in size was 23 (18.9 %). Follow-up duration did not differ according to the patient age or valve size (younger than 19 years or older than 19 years, smaller than 25 mm or larger than 25 mm).
Overall freedom from valvular dysfunction at 5 and 10 years was 95.7 % and 69.0 %, respectively. In younger patients (< 19 years), there was no significant difference in freedom from valvular dysfunction between the patients in whom a smaller valve was used (< 25 mm, 41.6% at 10 years) and those in whom a larger valve (≥ 25 mm, 68.4 % at 10 years, p-value = 0.1) was used. However, in older patients (≥ 19 years), there was no valvular dysfunction during the follow-up period regardless of the valve size. In cases with a larger valve was used (≥ 25 mm), there was no valvular dysfunction in older patients (≥ 19 years) (100 % freedom from dysfunction at 10 years vs. 68.4 % freedom from dysfunction at 10 years in younger patients); however, there was no statistical significance between older and younger (< 19 years) patients (p-value = 0.17).
Conclusion : The durability of commercial tissue valves in the pulmonary position was acceptable in the older patients (≥ 19 years) regardless of the valve size, and it was particularly excellent for larger valves (≥ 25 mm) until 10 years after PVR. However, in the patients aged < 19 years, the durability of tissue valves was suboptimal at 10 years, regardless of the valve size.
Methods : We retrospectively reviewed 122 cases of PVR with commercial tissue valves (bovine pericardial and porcine valve), which was performed between January 1998 and February 2014, in the patients after total correction of TOF. We excluded the patients who underwent PVR with stentless porcine valves, which showed significantly much worse outcomes than PVR with the other types of bioprosthetic valves. We defined valvular dysfunction as at least a moderate amount of PR or a peak pressure gradient ≥ 40 mmHg on the latest echocardiography.
Results : There were 2 early deaths and no late deaths. Follow-up duration (from the operation to the last echocardiography) was 57.2 ± 38.5 months, and 90.0 % (108 out of 120 patients) of patients were followed up. The mean age at PVR was 19.3 ± 9.1 years. The number of the patients younger than 19 years was 66 (54.1 %). The mean valve size was 24.8 ± 1.7 mm (range, 19 ~ 27 mm), and the number of the valves less than 25 mm in size was 23 (18.9 %). Follow-up duration did not differ according to the patient age or valve size (younger than 19 years or older than 19 years, smaller than 25 mm or larger than 25 mm).
Overall freedom from valvular dysfunction at 5 and 10 years was 95.7 % and 69.0 %, respectively. In younger patients (< 19 years), there was no significant difference in freedom from valvular dysfunction between the patients in whom a smaller valve was used (< 25 mm, 41.6% at 10 years) and those in whom a larger valve (≥ 25 mm, 68.4 % at 10 years, p-value = 0.1) was used. However, in older patients (≥ 19 years), there was no valvular dysfunction during the follow-up period regardless of the valve size. In cases with a larger valve was used (≥ 25 mm), there was no valvular dysfunction in older patients (≥ 19 years) (100 % freedom from dysfunction at 10 years vs. 68.4 % freedom from dysfunction at 10 years in younger patients); however, there was no statistical significance between older and younger (< 19 years) patients (p-value = 0.17).
Conclusion : The durability of commercial tissue valves in the pulmonary position was acceptable in the older patients (≥ 19 years) regardless of the valve size, and it was particularly excellent for larger valves (≥ 25 mm) until 10 years after PVR. However, in the patients aged < 19 years, the durability of tissue valves was suboptimal at 10 years, regardless of the valve size.
책임저자: 곽재건
세종병원
연락처 : 곽재건, Tel: 032-340-1449 , E-mail : switch.surgeon@gmail.com
