Investigating the Long-term Durability of Prosthetic Valves in Patients Who Have Undergone Tetralogy of Fallot Surgery with Transannular Patch

OBJECTIVES: This study aimed to determine the longevity of bioprosthetic valves (BPVs) or valved conduits in the pulmonary position and the factors associated with prosthetic valve longevity in patients who underwent surgical repair of tetralogy of Fallot (TOF). METHODS: We performed a single-centre retrospective study in patients undergoing placement of a bioprosthesis or valved conduit in patients operated for TOF with a transannular patch. The primary end-point was freedom from pulmonary valve replacement (PVR) reintervention. The composite secondary end-point was freedom from PVR reintervention and structural valve degeneration. RESULTS: A total of 211 patients undergoing 255 operations were identified. The median age at first PVR was 15.4 years (IQR 12.3-20.7 years). The freedom from reintervention at 5, 10, and 15 years was 94%, 77%, and 64%, respectively. Multivariable analysis shows that factors that are independently associated with a more significant hazard of reintervention are younger age, smaller valve size, and male sex. Of the implanted prosthetic valves, 122 were bioprosthesis; 38 (18%) were homografts; 37 (17%) percutaneous valve, and 14 (7%) were other prosthetic valves or conduits. The freedom from reintervention was not different between homografts and all other heterografts (P = 0.938). Percutaneous valves showed an average longevity of 9.4 years, significantly lower than other prosthetic valves (P = 0.007). CONCLUSIONS: Younger patient age and a smaller valve size were associated with reduced BPV durability. There is a concern about an early PVR to preserve right ventricle function overall during adolescent age.