THE IMPACT OF PULMONIC VALVE REPLACEMENT ON VENTRICULAR ARRHYTHMIAS ASSOCIATED WITH TETRALOGY OF FALLOT PATIENTS

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): INSERM - French Society of Cardiology OnBehalf DAIT4F Investigators Background Sudden cardiac death is a major cause of death in tetralogy of Fallot (TOF) and right ventricular overload is commonly considered as a potential trigger for ventricular arrhythmias. Purpose We aimed to assess the impact of pulmonary valve replacement (PVR) on ventricular arrhythmias burden using a population of TOF patients with continuous cardiac monitoring by implantable cardioverter defibrillator (ICD). Methods Nationwide French registry including all TOF patients with an ICD. Survival data with recurrent events were used to compare the burden of appropriate ICD therapies before and after PVR in patients who underwent PVR over the study period. Results A total of 165 patients (mean age 42.2 ± 13.3 years, 70.1% males) were included from 40 centers. Over a median (IQR) follow-up period of 6.8 (2.5-11.4) years, 26 (15.8%) patients underwent PVR. Among those patients, 18 (69.2%) experienced at least one appropriate ICD therapy. When considering all ICD therapies delivered before (n = 62) and after (n = 16) PVR, the burden of ICD appropriate therapies was significantly lower after PVR (HR 0.21, 95%CI 0.08-0.56, p = 0.002). In the overall cohort, PVR before ICD implantation was also independently associated with a lower risk of appropriate ICD therapy in primary prevention patients (HR 0.29, 95%CI 0.10-0.89, p = 0.031). Conclusions In this cohort of high-risk TOF patients implanted with an ICD, the burden of appropriate ICD therapies was significantly reduced after PVR. While optimal indications and timing for PVR are debated, these findings suggest the importance of considering ventricular arrhythmias in the overall making-decision process. Abstract Figure.

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Can 2-dimensional echocardiography accurately classify patients with repaired tetralogy of Fallot in possible need of pulmonic valve replacement?

Journal of Cardiovascular Magnetic Resonance ◽

10.1186/1532-429x-18-s1-p171 ◽

2016 ◽

Vol 18 (S1) ◽

Author(s):

Joyce Woo ◽

Waseem Cossor ◽

Shelby Kutty ◽

Roberto Lang ◽

Amit R Patel

Keyword(s):

Tetralogy Of Fallot ◽

Valve Replacement ◽

Pulmonic Valve ◽

Repaired Tetralogy Of Fallot ◽

Dimensional Echocardiography ◽

Pulmonic Valve Replacement

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Risk factors and long-term outcomes after tetralogy of Fallot repair at an Asian tertiary referral center

Asian Cardiovascular and Thoracic Annals ◽

10.1177/02184923211039795 ◽

2021 ◽

pp. 021849232110397

Author(s):

Paweena Chungsomprasong ◽

Pimonrat Somkittithum ◽

Prakul Chanthong ◽

Chodchanok Vijarnsorn ◽

Kritvikrom Durongpisitkul ◽

...

Keyword(s):

Risk Factors ◽

Tetralogy Of Fallot ◽

Valve Replacement ◽

Long Term Outcomes ◽

Pulmonic Valve ◽

Tetralogy Of Fallot Repair ◽

Pulmonic Valve Replacement ◽

Overall Mortality

Background Tetralogy of Fallot is the most common type of cyanotic congenital heart disease. More postoperative tetralogy of Fallot patients grow up than in the past, and these patients need to be followed-up. Objective To investigate the survival and long-term outcomes of patients who underwent total repair of tetralogy of Fallot, and to identify the risk factors for reoperation with pulmonic valve replacement. Method A total of 403 patients who underwent total tetralogy of Fallot repair at our center during 1997 to 2016 were retrospectively included. Demographic, clinical, treatment, outcome, and follow-up data were collected and analyzed. Results Median age and body weight at the time of tetralogy of Fallot repair was 4.41 years (range: 0.85–55.28) and 13.58 kg (range: 5.5–68), respectively. The median follow-up was 9.0 years, and overall mortality was 3.2%. The actuarial survival rates at 10 and 20 years were 96.4% and 95.2%, respectively, and the freedom from pulmonic valve replacement was 93.4% and 57.4%, respectively. The median time to indicate pulmonic valve replacement was 13.9 years (range: 6.2–20.5). Multivariate analysis revealed transannular patch technique (hazard ratio: 3.023, 95% confidence interval: 1.34–6.83; p = 0.008) and palliative shunt (hazard ratio: 2.39, 95% confidence interval: 1.16–4.91; p = 0.018) to be independent risk factors for reoperation with pulmonic valve replacement. Conclusion The rates of overall survival and freedom from pulmonic valve replacement were both high in this study, and both were comparable to the rates reported from other studies. Overall mortality was as low as 3.47%. The need for a transannular patch or palliative shunt should be considered risk factors for a consequent reoperation.

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Persistent end-diastolic forward flow after pulmonary valve replacement in patients with repaired tetralogy of Fallot

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezab098 ◽

2021 ◽

Author(s):

Yuji Tominaga ◽

Masaki Taira ◽

Takashi Kido ◽

Tomomitsu Kanaya ◽

Kanta Araki ◽

...

Keyword(s):

Tetralogy Of Fallot ◽

Valve Replacement ◽

Pulmonary Valve ◽

Pulmonary Valve Replacement ◽

Right Atrial ◽

Volume Index ◽

Forward Flow ◽

Repaired Tetralogy Of Fallot ◽

Increased Risk ◽

The Impact

Abstract OBJECTIVES The clinical significance of persistent end-diastolic forward flow (EDFF) after pulmonary valve replacement (PVR) remains unclear in patients with repaired tetralogy of Fallot. This study aimed to identify the characteristics of these patients and the impact of persistent EDFF on outcomes. METHODS Of 46 consecutive patients who underwent PVR for moderate to severe pulmonary regurgitation between 2003 and 2019, 23 (50%) did not show EDFF before PVR [group (−)]. In the remaining 23 patients with EDFF before PVR, EDFF was diminished after PVR in 13 (28%) [group (+, −)] and persisted in 10 (22%) [group (+, +)]. The following variables were compared between these 3 groups: (i) preoperative right ventricular (RV) and right atrial volumes measured by magnetic resonance imaging, haemodynamic parameters measured by cardiac catheterization and the degree of RV myocardial fibrosis measured by RV biopsy obtained at PVR and (ii) the post-PVR course, development of atrial arrhythmia and need for intervention. RESULTS A high RV end-diastolic pressure, a greater right atrial volume index and a greater RV end-systolic volume index before PVR and a high degree of RV fibrosis were significantly associated with persistent EDFF 1 year after PVR. Persistent EDFF was a significant risk factor for postoperative atrial tachyarrhythmia, and catheter ablation and pacemaker implantation were required more frequently in these patients. CONCLUSIONS Persistent EDFF after PVR could predict a worse prognosis, especially an increased risk of arrhythmia. Close follow-up is required in patients with persistent EDFF for early detection of arrhythmia and prompt reintervention if necessary. Clinical trial registration number Institutional review board of Osaka University Hospital, number 16105

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Orthotopic Pulmonic Valve Replacement with a Pulmonary Homograft as an Interposition Graft

Journal of Cardiac Surgery ◽

10.1111/j.1540-8191.1996.tb00075.x ◽

1996 ◽

Vol 11 (6) ◽

pp. 417-420 ◽

Cited By ~ 4

Author(s):

Jorge M. Balaguer ◽

John G. Byrne ◽

Lawrence H. Cohn

Keyword(s):

Valve Replacement ◽

Pulmonic Valve ◽

Interposition Graft ◽

Pulmonary Homograft ◽

Pulmonic Valve Replacement

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Comparison of Transcatheter Pulmonic Valve Implantation With Surgical Pulmonic Valve Replacement in Adults (from the National Inpatient Survey Dataset)

The American Journal of Cardiology ◽

10.1016/j.amjcard.2019.09.031 ◽

2020 ◽

Vol 125 (1) ◽

pp. 135-139 ◽

Cited By ~ 1

Author(s):

Arka Chatterjee ◽

Nirmanmoh Bhatia ◽

Maria Gutierrez Torres ◽

Marc G. Cribbs ◽

David C. Mauchley ◽

...

Keyword(s):

Valve Replacement ◽

Pulmonic Valve ◽

Valve Implantation ◽

Pulmonic Valve Replacement

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QRS Complex Enlargement as a Predictor of Ventricular Arrhythmias in Patients Affected by Surgically Treated Tetralogy of Fallot: A Comprehensive Literature Review and Historical Overview

ISRN Cardiology ◽

10.1155/2013/782508 ◽

2013 ◽

Vol 2013 ◽

pp. 1-8 ◽

Cited By ~ 8

Author(s):

Pier Paolo Bassareo ◽

Giuseppe Mercuro

Keyword(s):

Tetralogy Of Fallot ◽

Ventricular Arrhythmias ◽

Surgical Repair ◽

Strong Predictor ◽

Term Survival ◽

Qrs Prolongation ◽

Life Threatening ◽

Qrs Duration ◽

The Impact

Tetralogy of Fallot (TOF) is a congenital heart disease frequently treated by surgical repair to relieve symptoms and improve survival. However, despite the performing of an optimal surgical repair, TOF patients are at times characterized by a poor long-term survival rate, likely due to cardiac causes such as ventricular arrhythmias, with subsequent sudden death. In the 80s it was irrefutably demonstrated that QRS prolongation ≥180 msec at basal electrocardiogram is a strong predictor for refining risk stratification for ventricular tachycardia in these patients. The aim of this research was to undertake a review of all studies conducted to assess the impact of QRS duration on the development of life-threatening ventricular arrhythmias in repaired TOF subjects.

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