Surgical outcome after complete repair of tetralogy of Fallot with absent pulmonary valve: comparison between bovine jugular vein-valved conduit and monocusp-valve patch
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The prognosis of tetralogy of Fallot with absent pulmonary valve (TOF/APV) without operation is poor. We evaluated the surgical outcome of TOF/APV in a single center.
Twenty-two TOF/APV patients underwent complete surgical correction in our hospital. Right ventricular outflow tract reconstruction was performed using bovine jugular vein (BJV)-valved conduit implantation (n = 10), homograft-valved conduit implantation (n = 2), or monocusp-valve patch (n = 10). Health-related quality of life (QOL) was evaluated during follow-up.
The overall survival at 5 and 10 years was 86.4 ± 7.3% (confidence interval 69.4–97.2%). The survival rates were significantly different between patients with and without bronchial stenosis (40 and 100%, P = 0.0003, log-rank test). The survival of patients aged > 6 months was higher than those ≤ 6 months (100 vs. 40%, P = 0.0003, log-rank test). Patients with BJV-valved conduits had higher systolic gradients from the right ventricle to the pulmonary artery (RV–PA) compared to those with monocusp-valve patches. BJV-valved conduit implantation was a risk factor for post-operative pulmonary-valve stenosis. The QOL score for patients with BJV-valved conduits was lower than those with monocusp-valve patches (P < 0.05). No reoperation was performed during follow-up.
Bronchial stenosis and lower age (≤ 6 months) were the main factors influencing post-operative survival. The use of a BJV-valved conduit was a main reason for RV–PA restenosis; thus, the use of a BJV-valved conduit may increase the need for repeat intervention and decrease the post-operative quality of life.
KeywordsBovine jugular vein-valved conduit Bronchial stenosis Pulmonary stenosis Tetralogy of Fallot with absent pulmonary valve
ESW contributed to the conception and design, data collection, analysis, and interpretation, statistical analysis, writing of the article, and participated in the critical revision of the article and the language correction. XSF contributed to the conception and design, data collection, analysis, and interpretation. ESW and XSF contributed equally to this article. LX participated in data interpretation. SJL contributed to the critical revision of the article and the statistical analysis. HZ contributed to the conception and design, data analysis, critical revision of the article, and language correction. All authors read and approved the final version of the manuscript.
The study was supported by the National Natural Science Foundation of China (81400242 and 81525002) from ESW and HZ, and Program for Distinguished Professor in PUMC from HZ.
Compliance with ethical standards
The protocol of this study was carried out according to the principles of the Declaration of Helsinki and approved by the Medical Ethics Committee of Cardiovascular Institute and Fuwai Hospital. Written informed consent was obtained from all the participants before enrolment.
Conflict of interest
No financial or nonfinancial benefits have been received or will be received from any party related directly or indirectly to the subject of this article.
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