초록접수 현황
| 16F-286 | 구연 발표 |
Long Term Outcomes after Total Repair for Tetralogy of Fallot and the Predictive Factor of Pulmonary Valve Replacement: 25-year Follow-up
Ji Hyun Bang, Eung Rae Kim, Jae Gun Kwak, Woong-Han Kim, Jeong Ryul Lee, Yong Jin Kim
Department of Thoracic and Cardiovascular Surgery, Seoul National University Children’s Hospital, Seoul National University College of Medicine, Seoul, Korea
Background : This study sought the long term outcomes after surgical repair of tetralogy of Fallot
Methods : From January 1991 to December 1997, 180 patients with tetralogy of Fallot (age at repair 1.5 ± 1.4 years). The PV was bicuspid in 41 patients (35.0%), the Z value of PV was -3.6 ± 2.6. Finally, 180 patients (median followup, 23.2 ± 4.1 years) were enrolled; of these 84 patients (47%) underwent pulmonary valve replacement whereas 96 patients (53%) did not underwent PVR.
Results : At 25 year follow-up from date of TOF repair, freedom from death was 93.6%, arrhythmia 79.3% and surgical reintervention 49.0%. All detected ventricular arrhythmias were isolated monofocal premature ventricular contractions.
During follow-up, 164 (91.1%) patients were NYHA class 1-2. Mean QRS duration was 142 ± 28ms. MRI with mean right ventricular end-diastolic volume index 143 ± 39 ml/m2, right ventricular end-systolic volume index 76 ± 29ml/m2, and RV ejection fraction 45 ± 7%.
88 PVRs were performed in 84 patients at the age of 17.4 ± 6.2 years. A bicuspid PV (hazard ratio, 1.67; 95% confidence interval, 1.08-2.58; p=0.02), previous shunt history before TOF repair (HR, 2.68; 95% CI, 1.55-4.62; P < 0 .001) were the independent factors for requiring PVR. For sub-group analysis, sudden cardiac death occurred in ten non-PVR compared with one in PVR group (p=0.006). Freedom from arrhythmia at 25 years was 76.6 ± 0.1% in the PVR group and 78.9±0.1% in the non-PVR group (p=0.46). Oxygen consumption at peak exercise did not significantly change in either group (p=0.29).
Conclusion : The long-term outcomes after repair of tetralogy of Fallot were acceptable. PV morphology and the history of shunt implantation before repair of TOF were predictive factors for requiring PVR. In patients after TOF repair, early PVR strategy conferred a long-term survival adventage compared with non-PVR
Methods : From January 1991 to December 1997, 180 patients with tetralogy of Fallot (age at repair 1.5 ± 1.4 years). The PV was bicuspid in 41 patients (35.0%), the Z value of PV was -3.6 ± 2.6. Finally, 180 patients (median followup, 23.2 ± 4.1 years) were enrolled; of these 84 patients (47%) underwent pulmonary valve replacement whereas 96 patients (53%) did not underwent PVR.
Results : At 25 year follow-up from date of TOF repair, freedom from death was 93.6%, arrhythmia 79.3% and surgical reintervention 49.0%. All detected ventricular arrhythmias were isolated monofocal premature ventricular contractions.
During follow-up, 164 (91.1%) patients were NYHA class 1-2. Mean QRS duration was 142 ± 28ms. MRI with mean right ventricular end-diastolic volume index 143 ± 39 ml/m2, right ventricular end-systolic volume index 76 ± 29ml/m2, and RV ejection fraction 45 ± 7%.
88 PVRs were performed in 84 patients at the age of 17.4 ± 6.2 years. A bicuspid PV (hazard ratio, 1.67; 95% confidence interval, 1.08-2.58; p=0.02), previous shunt history before TOF repair (HR, 2.68; 95% CI, 1.55-4.62; P < 0 .001) were the independent factors for requiring PVR. For sub-group analysis, sudden cardiac death occurred in ten non-PVR compared with one in PVR group (p=0.006). Freedom from arrhythmia at 25 years was 76.6 ± 0.1% in the PVR group and 78.9±0.1% in the non-PVR group (p=0.46). Oxygen consumption at peak exercise did not significantly change in either group (p=0.29).
Conclusion : The long-term outcomes after repair of tetralogy of Fallot were acceptable. PV morphology and the history of shunt implantation before repair of TOF were predictive factors for requiring PVR. In patients after TOF repair, early PVR strategy conferred a long-term survival adventage compared with non-PVR
첨부파일 : PVR non-PVR.pptx
책임저자: Woong-Han Kim
Department of Thoracic and Cardiovascular Surgery, Seoul National University Children’s Hospital, Seoul National University College of Medicine, Seoul, Korea
발표자: Woong-Han Kim, E-mail : woonghan@snu.ac.kr