Outcome after repair of tetralogy of Fallot with absent pulmonary valve
| Autor: | Jack Rychik, J. William Gaynor, Thomas L. Spray, William M. DeCampli, Gary W. Raff, Bryan E McDonnell, Rudolfo I Godinez |
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| Rok vydání: | 1999 |
| Předmět: |
Pulmonary and Respiratory Medicine
Male Reoperation medicine.medical_specialty Heart disease Adolescent medicine.medical_treatment medicine.artery medicine Extracorporeal membrane oxygenation Intubation Intratracheal Intubation Ventricular outflow tract Humans Child Tetralogy of Fallot Proportional Hazards Models Pulmonary Valve business.industry Infant Newborn Infant medicine.disease Survival Analysis Surgery medicine.anatomical_structure Treatment Outcome Respiratory failure Pulmonary valve Child Preschool Pulmonary artery Female Cardiology and Cardiovascular Medicine business |
| Zdroj: | The Annals of thoracic surgery. 67(5) |
| ISSN: | 0003-4975 |
| Popis: | Background . Tetralogy of Fallot with absent pulmonary valve (TOF/APV) is associated with pulmonary artery dilatation and airway compression. Methods . Since January 1, 1984, 28 patients with TOF/APV have undergone complete repair (median age 11 days, range 1 day to 16 years). Results . Thirteen patients were ventilated for respiratory failure preoperatively and extracorporeal membrane oxygenation was used in 3. Twenty-six patients underwent pulmonary artery plication (11 anterior, 15 anterior/posterior). The right ventricular outflow tract (RVOT) was reconstructed with a patch (19), valved conduit (5), or monocusp valve (4). Early mortality was 21.4% (6/28), with 1 late death. All early deaths occurred in infants intubated preoperatively. Survival was 77% (95% confidence limit [CL] 56%, 89%) at 1 year and 72% (95% CL 50%, 86%) at 10 years. After surgery, 3 patients underwent reoperation for persistent respiratory symptoms, which resolved after repeat plication and placement of a valved conduit. Freedom from death or reoperation was 68% (95% CL 46%, 83%) at 1 year and 52% (95% CL 29%, 71%) at 10 years. In a multivariable analysis, only preoperative intubation was associated with a worse outcome ( p = 0.04). Conclusions . Long-term outcome for patients with TOF/APV who survive the initial repair is good. Repeat plication and pulmonary valve implantation may improve outcome in patients with persistent airway compression. |
| Databáze: | OpenAIRE |
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