Pulmonary valve replacement in repaired tetralogy of Fallot: Determinants of early postoperative adverse outcomes

Objective

We sought to examine the frequency of early postoperative complications and preoperative predictors of prolonged hospitalization in adults with repaired tetralogy of Fallot undergoing pulmonary valve replacement.

Methods

This was a retrospective study of consecutive adult patients undergoing surgical intervention between 1995 and 2006. A multivariate logistic regression model was used to identify determinants of prolonged hospitalization.

Results

One hundred sixteen patients (mean age, 36 ± 11 years) underwent 118 pulmonary valve replacements. Most (95%) operations included additional procedures, such as pulmonary artery/outflow tract reconstruction or tricuspid valve annuloplasty. The early postoperative mortality (<30 days) was 2.5%. The majority of the patients (60%) had no postoperative complications. The postoperative adverse events included postoperative arrhythmias (19%), respiratory complications (13%), reoperation during admission (13%), renal dysfunction (13%), and myocardial infarction (3%). Postoperative adverse events were associated with prolonged hospitalization (14 ± 12 vs 7 ± 3 days, P = .001). In the multivariate analysis age at reoperation of greater than 45 years (odds ratio, 6.1; 95% confidence interval, 1.6–23.6; P = .009), the number of previous sternotomies (odds ratio, 3.8; 95% confidence interval, 1.4–10; P = .007), and the need for urgent surgical intervention (odds ratio, 5.7; 95% confidence interval, 1.1–27.8; P = .03) were predictors of prolonged hospitalization.

Conclusion

Pulmonary valve replacement in adults with repaired tetralogy of Fallot has a low mortality risk. The most common early postoperative complications are arrhythmias and respiratory and renal complications. Although most early postoperative complications do not result in long-term sequelae, they are associated with prolonged hospitalization. Patients undergoing urgent interventions, older patients, and those with multiple previous sternotomies are at the highest risk for prolonged hospitalization.

Abbreviations and Acronyms: CI, confidence interval, OR, odds ratio, PAE, postoperative adverse event, PLOS, postoperative length of stay, PVR, pulmonary valve replacement, RVOT, right ventricular outflow tract, TOF, tetralogy of Fallot

CTSNet classification: 21