Background
Pulmonary valve replacement (PVR) is recommended for severe pulmonary regurgitation
in repaired tetralogy of Fallot (rTOF).
Objective
The purpose of this study was to investigate the event rate and effectiveness of PVR.
Methods
A retrospective study of tetralogy of Fallot patients who survived total repair from
1970 to 2020 was conducted.
Results
We identified 1744 rTOF patients; 86.6% with classic rTOF, 11.5% with pulmonary atresia,
0.8% with endocardial cushion defect, and 1.1% with absent pulmonary valve. Annual
risks of tachyarrhythmia/sudden cardiac arrest (SCA) increased to 0.295% and 1.338%
in patients aged 10–30 and 30–60 years, respectively, without sex predominance. PVR
(223 surgical and 39 percutaneous) event rate was 34.7% ± 2.1% by 30 years after repair
(annual risk: 1.57% between 10 and 30 years after repair). The second PVR rate was
9.9% ± 4.1% by 20 years after the first PVR. Tachyarrhythmia/SCA risk was higher in
PVR patients than in No PVR patients and was reduced in PVR patients without tachyarrhythmia/SCA
before PVR. However, survival in patients with ventricular tachyarrhythmia/SCA still
was better after PVR. At PVR, 13% of patients had tachyarrhythmia/SCA, which was the
major predictor of events after PVR. Before PVR, although the ventricular tachyarrhythmia/SCA
risks included QRS duration >160 ms and New York Heart Association functional class
III or IV, supraventricular tachyarrhythmia was associated with PVR age ≥28 years
and N-terminal pro–brain natriuretic peptide >450 pg/mL.
Conclusion
Tachyarrhythmia/SCA occurrence and the need for PVR increased with age during young
adulthood. PVR reduced subsequent arrhythmias only in those patients without arrhythmias
before PVR.
Keywords
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Article info
Publication history
Published online: June 30, 2022
Footnotes
Funding Sources: This study was supported by grants from the Taiwan Ministry of Science and Technology (109-2314-B-002 -130 -MY3, 109-2314-B-002 -283, and 110-2314-B-002 -283). Disclosures: All authors have reported that they have no relationships relevant to the contents of this paper to disclose.
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