Volume 15, Issue 1, Pages (January 2012)

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Volume 15, Issue 1, Pages 27-33 (January 2012) Timing and Technique of Pulmonary Valve Replacement in the Patient With Tetralogy of Fallot James S. Tweddell, Pippa Simpson, Shun-Hwa Li, Jennifer Dunham-Ingle, Peter J. Bartz, Michael G. Earing, Andrew N. Pelech Seminars in Thoracic & Cardiovascular Surgery: Pediatric Cardiac Surgery Annual Volume 15, Issue 1, Pages 27-33 (January 2012) DOI: 10.1053/j.pcsu.2012.01.007 Copyright © 2012 Elsevier Inc. Terms and Conditions

Figure 1 Long-term survival curve of 490 early survivors of repair of TOF. The curve shows two different phases that are distinct. The early, low-risk phase lasts 25 years; thereafter, the risk increases significantly. Mortality risk (r) per year, as a linearized number, is calculated for each phase. (Reprinted with permission.1) Seminars in Thoracic & Cardiovascular Surgery: Pediatric Cardiac Surgery Annual 2012 15, 27-33DOI: (10.1053/j.pcsu.2012.01.007) Copyright © 2012 Elsevier Inc. Terms and Conditions

Figure 2 Survival curve showing freedom from sudden death after repair of TOF comparing patients who had a transannular patch for RVOT reconstruction with those who did not during tetralogy repair. The risk of sudden death was significantly higher among patients with a transannular patch. Patients with a transannular patch would be anticipated to have significant PR. (Reprinted with permission.2) Seminars in Thoracic & Cardiovascular Surgery: Pediatric Cardiac Surgery Annual 2012 15, 27-33DOI: (10.1053/j.pcsu.2012.01.007) Copyright © 2012 Elsevier Inc. Terms and Conditions

Figure 3 Survival curves from a case control study comparing 77 patients who underwent PVR with 77 matched patients who did not undergo PVR. Survival was not improved among patients who underwent PVR. (Reprinted with permission.4) Seminars in Thoracic & Cardiovascular Surgery: Pediatric Cardiac Surgery Annual 2012 15, 27-33DOI: (10.1053/j.pcsu.2012.01.007) Copyright © 2012 Elsevier Inc. Terms and Conditions

Figure 4 NYHA functional class before and at last follow-up in patients undergoing PVR after TOF repair. (Reprinted with permission.6) Seminars in Thoracic & Cardiovascular Surgery: Pediatric Cardiac Surgery Annual 2012 15, 27-33DOI: (10.1053/j.pcsu.2012.01.007) Copyright © 2012 Elsevier Inc. Terms and Conditions

Figure 5 The impact of PVR on RV end-diastolic (A) and RV end-systolic (B) volumes as determined by CMR. Among 17 patients, baseline CMR imaging studies were performed at a mean of 10 ± 9 months before PVR and postoperative CMR imaging at a mean of 21 ± 11 months after PVR. Whereas volumes were reduced in all 17 patients after PVR those with a preoperative RV end-diastolic volume <170 mL/m2 had a late RV end-diastolic volume within the normal range and those with a preoperative RV end-systolic volume <85 mL/m2 had a late RV end-systolic volume within the normal range. Dashed horizontal line represents normal volume. (Reprinted with permission.22) Seminars in Thoracic & Cardiovascular Surgery: Pediatric Cardiac Surgery Annual 2012 15, 27-33DOI: (10.1053/j.pcsu.2012.01.007) Copyright © 2012 Elsevier Inc. Terms and Conditions

Figure 6 In this study, 88 patients with a median time from TOF repair of 20.7 years underwent CMR and were then followed for a median time of 4.2 years. The figure shows the probability of major adverse clinical outcomes (death, sustained ventricular tachycardia, or an increase in NYHA class to grade III or IV) based on multivariate logistic regression model containing RV end-diastolic volume (RVEDV) Z-score and RV ejection fraction (RVEF). (Reprinted with permission.24) Seminars in Thoracic & Cardiovascular Surgery: Pediatric Cardiac Surgery Annual 2012 15, 27-33DOI: (10.1053/j.pcsu.2012.01.007) Copyright © 2012 Elsevier Inc. Terms and Conditions

Figure 7 Surgical technique for PVR. A, A stented bioprosthetic valve is sewn into the orthotopic position in the RVOT. B, The RVOT is augmented with a patch as necessary to accommodate the valve. Seminars in Thoracic & Cardiovascular Surgery: Pediatric Cardiac Surgery Annual 2012 15, 27-33DOI: (10.1053/j.pcsu.2012.01.007) Copyright © 2012 Elsevier Inc. Terms and Conditions

Figure 8 Survival of patients over 5 years of age undergoing PVR for TOF and variants. There was no significant difference in survival among patients receiving a homograft compared with a heterograft. Seminars in Thoracic & Cardiovascular Surgery: Pediatric Cardiac Surgery Annual 2012 15, 27-33DOI: (10.1053/j.pcsu.2012.01.007) Copyright © 2012 Elsevier Inc. Terms and Conditions

Figure 9 Freedom from reintervention and death among patients over 5 years of age undergoing PVR for TOF and variants. There was no significant difference in reintervention-free survival among patients receiving a homograft compared with a heterograft. Seminars in Thoracic & Cardiovascular Surgery: Pediatric Cardiac Surgery Annual 2012 15, 27-33DOI: (10.1053/j.pcsu.2012.01.007) Copyright © 2012 Elsevier Inc. Terms and Conditions