Pulmonary Valve Replacement in Adult Patients after Tetralogy of Fallot Type Operative Repair

Akihiro Masuzawa, KONDO RYOUITI, TETUHIRO TAKAOKA, YASUTAKA HIRATA, MINORU ONO

The University of Tokyo Hospital, Tokyo, Japan

Date, time and location: 2018.05.26 17:00, Press Hall, 2F

Abstract

The number of Pulmonary valve replacement (PVR) in patients with a history of tetralogy of Fallot type repair is increasing. Our standard choice of valve is stented bioprosthetic valve considering free of warfarin. The prosthesis is sutured with 4-0 continuous running suture in a slanted position facing posteriorly.  When conduit repair is required, handmade EPTFE tri-leaflet valved EPTFE conduit for small diameter and stented bioprosthetic valve inserted conduit for large diameter is used. Allograft is indicated only for a patient with infective endocarditis or mediastinitis. Institutional medical records were retrospectively reviewed for last 16 years. There were 11 male and 12 female patients. Mean age was 36.6+/-10.6 years (20-61 years). In the early era (2002-2009), there were 4 PVR including 2 pulmonary allograft replacement, and in the same era 4 release of pulmonary stenosis. In the late era (2010-1017), there were 19 PVR and 2 release of pulmonary stenosis. Conduit repair with 2 tri-leaflet handmade conduits and 1 bioprosthetic valved conduit were performed.  There was no surgery-related death. Implanted valve size was from 19mm to 27mm (mean 25+/-2mm). Concomitant procedures were distal pulmonary artery plasty, right ventricular outflow repair, mitral valve plasty, MAZE procedure, aortic valve replacement, tricuspid valve replacement, residual ventricular septal defect closure, and atrial septal defect closure. In conclusion, pulmonary valve replacement for dramatically increasing patients who underwent tetralogy of Fallot type repair many years ago was performed safely.