Open Access

ARTICLE

Long-Term Outcome and Risk Factor Analysis of Surgical Pulmonary Valve Replacement in Congenital Heart Disease

by Woo Young Park¹, Gi Beom Kim^1,*, Sang Yun Lee¹, Mi Kyoung Song¹, Hye Won Kwon¹, Hyo Soon An¹, Eun Jung Bae¹, Sungkyu Cho², Jae Gun Kwak², Woong-Han Kim²

1 Department of Pediatrics, Seoul National University Children’s Hospital, Seoul National University College of Medicine, Seoul, Korea
2 Department of Thoracic and Cardiovascular Surgery, Seoul National University Children’s Hospital, Seoul National University College of Medicine, Seoul, Korea

* Corresponding Author: Gi Beom Kim. Email:

Congenital Heart Disease 2022, 17(3), 335-350. https://doi.org/10.32604/chd.2022.018666

Received 09 September 2021; Accepted 14 February 2022; Issue published 03 May 2022

Abstract

Objectives: To establish long-term outcome of surgical pulmonary valve replacement (PVR) in congenital heart disease (CHD) and to identify risk factors for overall mortality, operative mortality, and repetitive PVR. Methods: This is a retrospective study of 375 surgical PVR in 293 patients who underwent surgical PVR for CHD between January 2000 and May 2020. We only included patients with index PVR with previous open-heart surgery regardless of the number of PVRs. The previous surgical history of patients who underwent PVR during the study period was also included. Patients who underwent the Rastelli operation, and those who underwent single PVR without previous open-heart surgery were excluded. Results: The median age of the patients at the time of surgical PVR was 14.9 years (Interquartile range, IQR, 11.0–22.0). The median follow-up duration was 10.5 years (IQR, 5.5–14.8 years). There were 3 patients with operative mortality (1.0%) and 15 patients with overall mortality (5.1%). The survival rate was 95.1% over 20 years follow-up period. Multivariate analysis demonstrated that more than 3 times of previous open-heart surgeries before surgical PVR, older age at the first operation, longer cardiopulmonary bypass (CPB) time and longer intensive care unit (ICU) stay were predictors for overall mortality. Patients who underwent surgical PVR after more than 3 times of previous open-heart surgeries had significantly higher mortality than those who underwent open-heart surgeries less than 3 times (P < 0.001). Age younger than 10 years, male, multiple valve problems and longer ICU stay were significant predictors for repetitive PVR by multivariate analysis. Conclusions: Though surgical PVR has excellent long-term outcome, it should be performed with caution for those who previously underwent multiple open-heart surgeries, especially if patient received more than 3 times of open-heart surgeries.

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Keywords

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