PULMONARY VALVE-REPLACEMENT LATE AFTER REPAIR OF TETRALOGY OF FALLOT

Background. Pulmonary valve incompetence is usually well tolerated aft er tetralogy of Fallot repair but may result in late progressive right heart failure as manifested by increasing fatigue, dyspnea, and frequ ently arrhythmias. Methods. All patients who underwent pulmonary valve replacement in our center late after repair of tetralogy of Fallot we re reviewed. Results. Eighty-five patients had elective pulmonary valv e replacement late (median, 9.3 years) after repair. Operative risk wa s low (1.1%). Ninety percent of survivors are in New York Heart Associ ation class I. Survival 10 years after pulmonary valve replacement is 95%, with 86% of the patients free of reoperation for valve failure. C onclusions. Pulmonary valve replacement is infrequently required after repair of tetralogy of Fallot. Pulmonary valve replacement may be per formed electively with little risk; it improves symptoms of right hear t failure and provides satisfactory long-term survival with low risk o f early valve failure. As the population of patients who have had repa ir of tetralogy of Fallot ages, pulmonary valve replacement will becom e a more frequent consideration. (C) 1997 by The Society of Thoracic S urgeons.