2017-02-15
The unnatural history of pulmonary stenosis up to 40 years after surgical repair
Publication
Publication
Heart , Volume 103 - Issue 4 p. 273- 279
Objective To provide prospective information on
long-term outcome after surgical correction of valvular
pulmonary stenosis (PS).
Methods Fifty-three consecutive patients operated for
PS during childhood between 1968 and 1980 in one
centre are followed longitudinally for 37±3.4 years,
including extensive in-hospital examination every
10 years.
Results Survival information was available in 100% of
the original 53 patients. Cumulative survival was 94% at
20 years and 91% at 40 years. Excluding perioperative
mortality (<30 days), survival was 94% at 40 years. Of
46 eligible survivors, 29 participated in the in-hospital
examination and 15 gave permission to use their
hospital records (96% participation). Cumulative eventfree
survival was 68% after 40 years: 25% needed a
reintervention, 12% underwent pacemaker implantation
and 9% had supraventricular arrhythmias. Early
reinterventions were mainly for residual PS, late
reinterventions for pulmonary regurgitation. Subjective
health status was good. Exercise capacity was normal in
74% (median 96 (82–107)% of expected workload).
Right ventricular and left ventricular (LV) dysfunction was
found in 13% and 41%, respectively. The use of a
transannular patch and younger age at surgery were
predictive for late events (HR 3.02 (95% CI 1.09 to
8.37) and HR 0.81/year (95% CI 0.66 to 0.98),
respectively). Use of inflow occlusion compared with
cardiopulmonary bypass showed a trend towards more
reinterventions (HR 3.19 (95% CI 0.97 to 10.47)).
Conclusions Survival up to 40 years after successful
PS repair is nearly normal. Subjective health status is
good and there is a low incidence of arrhythmias.
Reinterventions, however, are necessary in one-quarter
and 40 years postoperatively several patients show LV
dysfunction.
Additional Metadata | |
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doi.org/10.1136/heartjnl-2015-309159, hdl.handle.net/1765/96744 | |
Heart | |
Organisation | Department of Cardiology |
Cuypers, J., Menting, M., Opic, P., Utens, E., Helbing, W., Witsenburg, M., … Roos-Hesselink, J. (2017). The unnatural history of pulmonary stenosis up to 40 years after surgical repair. Heart, 103(4), 273–279. doi:10.1136/heartjnl-2015-309159 |