Hostname: page-component-cd9895bd7-q99xh Total loading time: 0 Render date: 2024-12-18T11:08:12.207Z Has data issue: false hasContentIssue false
  • English
  • Français

Factors related to the durability of a homograft monocusp valve inserted during repair of tetralogy of Fallot as based on the mid- to long-term outcomes*

Published online by Cambridge University Press:  06 February 2008

Ji-Hyuk Yang ,
Tae-Gook Jun ,
Pyo W. Park ,
Kiick Sung ,
Wook S. Kim ,
Young T. Lee ,
June Huh ,
I-Seok Kang  and
Heung J. Lee
Ji-Hyuk Yang
Affiliation:
Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
Tae-Gook Jun*
Affiliation:
Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
Pyo W. Park
Affiliation:
Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
Kiick Sung
Affiliation:
Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
Wook S. Kim
Affiliation:
Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
Young T. Lee
Affiliation:
Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
June Huh
Affiliation:
Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
I-Seok Kang
Affiliation:
Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
Heung J. Lee
Affiliation:
Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
*
Correspondence to: Tae-Gook Jun, 135-710, Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, lrwon-dong 50, Gangnam-gu, Seoul, Korea. Tel: +82-2-3410-3484; Fax: +82-2-3410-0089; E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives

To maintain pulmonary valvar function subsequent to repair of tetralogy of Fallot, we have inserted a homograft monocusp when a transjunctional patch was required. In this study, we have evaluated the mid- to long-term outcomes, aiming to determine the durability of the homograft.

Methods

Among 218 repairs performed for tetralogy of Fallot between July, 1996, and June, 2005, we inserted homograft monocusps in 54 patients, 4 of whom had associated absent pulmonary valve syndrome, 3 had pulmonary valvar atresia, and 1 had an atrioventricular septal defect with common atrioventricular junction. The median body weight at surgery was 7.8 kilograms, with a range from 3.9 to 42 kilograms. The function of the monocusp valve was assessed by regular echocardiography, using the Kaplan-Meier method and the Cox regression model for statistical analyses.

Results

There were 2 early deaths (3.7%), associated with respiratory infection. No late deaths were observed during the follow-up, which ranged from 0.3 to 120 months, with a median of 64.3 months. Freedom from valvar dysfunction was 67.2 ± 6.7% at 1 year, 37.1 ± 7.3% at 3 years, 23.8 ± 6.7% at 5 years, and 21.2 ± 6.4% at 7 years. We needed to replace the valve in 1 patient during follow-up. We found that ABO blood group incompatibility, stenosis of the pulmonary arteries, and associated absent pulmonary valve syndrome all adversely affected the function of the monocusp.

Conclusion

Our experiences show that insertion of a homograft monocusp can prevent pulmonary regurgitation in the early period after repair of tetralogy of Fallot, but the effects are limited in duration as degeneration progressed. We still need to determine whether this finding can improve the longer-term function of the right ventricle.

Keywords

Congenital heart diseasecyanotic heart diseaseheart valveallograftpulmonary valveassessment of outcomes
Type
Original Article
Information
Cardiology in the Young , Volume 18 , Issue 2 , April 2008 , pp. 141 - 146
Copyright
Copyright © Cambridge University Press 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

*

The presentation on which this work is based was given at the Inaugural Meeting of The World Society for Pediatric and Congenital Heart Surgery in Washington DC, United States of America, May 3 and 4, 2007.

References

1. Hugel, W, Hannekum, A, Schreiber, S, Dalichau, H. The hemodynamics and contractility of the right ventricle in the early postoperative phase following correction of tetralogy of Fallot. Thorac Cardiovasc Surg 1984; 32: 253–255.CrossRefGoogle ScholarPubMed
2. Bouzas, B, Kilner, PJ, Gatzoulis, MA. Pulmonary regurgitation: not a benign lesion. Eur Heart J 2005; 26: 433–439.CrossRefGoogle Scholar
3. Cheung, MM, Konstantinov, IE, Redington, AN. Late complications of repair of tetralogy of Fallot and indications for pulmonary valve replacement. Semin Thorac Cardiovasc Surg 2005; 17: 155–159.CrossRefGoogle ScholarPubMed
4. Frigiola, A, Redington, AN, Cullen, S, Vogel, M. Pulmonary regurgitation is an important determinant of right ventricular contractile dysfunction in patients with surgically repaired tetralogy of Fallot. Circulation 2004; 110: II153–II157.CrossRefGoogle ScholarPubMed
5. Davies, J, Katsumata, T, Westaby, S. Procurement and processing of human heart valves: the Oxford Heart Valve Bank Protocol. In: Piwnika, A, Westaby, S (ed). Surgery for acquired aortic valve disease, 1st ed. Isis Medical Media, London, 1997, pp. 226–241.Google Scholar
6. Jun, TG, Park, PW, Park, KH, Chae, H, Kang, IS, Lee, HJ. Homologous monocuspid valve patch in right ventricular outflow tract reconstruction. J Cardiovasc Surg (Torino) 2001; 42: 17–21.Google ScholarPubMed
7. Jonsson, H, Ivert, T, Jonasson, R, Holmgren, A, Bjork, VO. Work capacity and central hemodynamics thirteen to twenty-six years after repair of tetralogy of Fallot. J Thorac Cardiovasc Surg 1995; 110: 416–426.CrossRefGoogle ScholarPubMed
8. Jonsson, H, Ivert, T, Jonasson, R, Wahlgren, H, Holmgren, A, Bjork, VO. Pulmonary function thirteen to twenty-six years after repair of tetralogy of Fallot. J Thorac Cardiovasc Surg 1994; 108: 1002–1009.CrossRefGoogle ScholarPubMed
9. Turrentine, MW, McCarthy, RP, Vijay, P, McConnell, KW, Brown, JW. PTFE monocusp valve reconstruction of the right ventricular outflow tract. Ann Thorac Surg 2002; 73: 871–879; discussion 879–880.CrossRefGoogle ScholarPubMed
10. Bigras, JL, Boutin, C, McCrindle, BW, Rebeyka, IM. Short-term effect of monocuspid valves on pulmonary insufficiency and clinical outcome after surgical repair of tetralogy of Fallot. J Thorac Cardiovasc Surg 1996; 112: 33–37.CrossRefGoogle ScholarPubMed
11. Gundry, SR, Razzouk, AJ, Boskind, JF, Bansal, R, Bailey, LL. Fate of the pericardial monocusp pulmonary valve for right ventricular outflow tract reconstruction. Early function, late failure without obstruction. J Thorac Cardiovasc Surg 1994; 107: 908–912; discussion 912–903.CrossRefGoogle ScholarPubMed
12. Ionescu, MI, Tandon, AP, Macartney, FJ. Long-term sequential hemodynamic evaluation of right ventricular outflow tract reconstruction using a valve mechanism. Ann Thorac Surg 1979; 27: 426–434.CrossRefGoogle ScholarPubMed
13. Sung, SC, Kim, S, Woo, JS, Lee, YS. Pulmonic valve annular enlargement with valve repair in tetralogy of Fallot. Ann Thorac Surg 2003; 75: 303–305.CrossRefGoogle ScholarPubMed
14. Kurosawa, H, Morita, K, Yamagishi, M, Shimizu, S, Becker, AE, Anderson, RH. Conotruncal repair for tetralogy of Fallot: midterm results. J Thorac Cardiovasc Surg 1998; 115: 351–360.CrossRefGoogle ScholarPubMed
15. Roughneen, PT, DeLeon, SY, Parvathaneni, S, Cetta, F, Eidem, B, Vitullo, DA. The pericardial membrane pulmonary monocusp: surgical technique and early results. J Card Surg 1999; 14: 370–374.CrossRefGoogle ScholarPubMed
16. Niwaya, K, Sakaguchi, H, Kawachi, K, Kitamura, S. Effect of warm ischemia and cryopreservation on cell viability of human allograft valves. Ann Thorac Surg 1995; 60: S114–S117.CrossRefGoogle ScholarPubMed
17. Gall, KL, Smith, SE, Willmette, CA, O’Brien, MF. Allograft heart valve viability and valve-processing variables. Ann Thorac Surg 1998; 65: 1032–1038.CrossRefGoogle ScholarPubMed
18. Kang, IS, Redington, AN, Benson, LN, et al. Differential regurgitation in branch pulmonary arteries after repair of tetralogy of Fallot: a phase-contrast cine magnetic resonance study. Circulation 2003; 107: 2938–2943.CrossRefGoogle ScholarPubMed
19. Sievers, HH, Storde, U, Rohwedder, EB, et al. Superior function of a bicuspid over a monocuspid patch for reconstruction of a hypoplastic pulmonary root in pigs. J Thorac Cardiovasc Surg 1993; 105: 580–590.CrossRefGoogle Scholar
20. Bechtel, JF, Lange, PE, Sievers, HH. Optimal size of a monocusp patch for reconstruction of a hypoplastic pulmonary root: an experimental study in pigs. Ann Thorac Surg 2005; 79: 2103–2108.CrossRefGoogle ScholarPubMed