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

Journal article
Authors Kristofer Skoglund
Gunnar Svensson
Ulf Thilén
Mikael Dellborg
Peter J Eriksson
Published in Scandinavian cardiovascular journal : SCJ
Volume 51
Issue 5
Pages 284-291
ISSN 1651-2006
Publication year 2017
Published at Institute of Medicine, Department of Molecular and Clinical Medicine
Pages 284-291
Language en
Links dx.doi.org/10.1080/14017431.2017.13...
www.ncbi.nlm.nih.gov/entrez/query.f...
Keywords 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
Subject categories Clinical Medicine

Abstract

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.

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