Long-term outcome after right ventricle to pulmonary artery conduit surgery and reintervention.

• Reconstruction of the right ventricular outflow tract with a conduit is an established surgical procedure in congenital heart disease and reinterventions are common.An increasing number of patients have a conduit, but there are few population-based studies of long-term outcomes after conduit surgery, reoperations, and transcatheter pulmonary valve replacement.In April 2015, all adult patients with a conduit were identified in the Swedish National Registry for Congenital Heart Disease (SWEDCON). Data on patients who died before age of 16 years are not included in the registry and thus not included in the study.We found 574 patients with a mean age 36.1 years. The largest proportion had tetralogy of Fallot (45%). In total there were 762 operations and 50 transcatheter pulmonary valve replacements. Mean age at first conduit operation was 20.2 years. Long-term survival up to 48 years including perioperative mortality (<1%) was 93% at 20 years. The most common cause of death was cardiac-related. Higher age at first conduit operation was associated with increased mortality risk. Reintervention-free survival was 77% and 54% at 10 and 20 years, respectively. Conduit reinterventions were common. Ten-year reintervention-free survival after first conduit reintervention (n=176) was significantly lower than after first conduit operation (70% vs 77% p=.04). Higher age at first conduit operation was associated with a reduced risk of reintervention, whereas male sex and complex malformations were associated with increased risk of reintervention.The mortality of repeated conduit reinterventions is low. The need for reintervention of conduits is considerable, and reintervention-free survival after the first conduit reintervention is poorer than after first conduit implantation. The findings in this study only applies for patients reaching 16 years of age.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine (hsv//eng)

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Kardiologi (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)

Nyckelord

Adolescent

Adult

Aged

Blood Vessel Prosthesis Implantation

adverse effects

mortality

Disease-Free Survival

Female

Heart Defects

Congenital

diagnosis

mortality

physiopathology

surgery

Heart Valve Prosthesis Implantation

adverse effects

mortality

Heart Ventricles

physiopathology

surgery

Humans

Kaplan-Meier Estimate

Male

Middle Aged

Postoperative Complications

surgery

Proportional Hazards Models

Pulmonary Artery

physiopathology

surgery

Registries

Reoperation

Retrospective Studies

Risk Factors

Sweden

Time Factors

Treatment Outcome

Young Adult

conduit

Congenital heart disease

reintervention

transcatheter pulmonary valve replacement

Publikations- och innehållstyp

ref (ämneskategori)

art (ämneskategori)