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J Thorac Cardiovasc Surg 2009;138:553-559
© 2009 The American Association for Thoracic Surgery

Congenital Heart Disease

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

^a Toronto Congenital Cardiac Center for Adults, Toronto General Hospital/University Health Network, Toronto, Ontario, Canada
^b Hospital for Sick Children, Toronto, Ontario, Canada
^c Unitat de Cardiopaties Congènites de l'Adolescent I de l'Adult (UCCAA), Àrea del Cor, Hospital de la Vall d'Hebron, Barcelona, Spain
^d CIBER de Epidemiología y Salud Pública (CIBERESP)–Unitat d'Epidemiologia, Servei de Cardiologia, Hospital de la Vall d'Hebron, Barcelona, Spain

Received for publication June 14, 2008; revisions received January 5, 2009; accepted for publication February 25, 2009.

^_* Address for reprints: Laura Dos, MD, Unitat de Cardiopaties Congènites de l'Adolescent i de l'Adult (UCCAA), Àrea del Cor, Hospital Universitari Materno-Infantil Vall d'Hebron, Avinguda de la Vall d'Hebron 119-129, 08035-Barcelona, Spain. (Email: laura_dos_subira{at}hotmail.com).

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.