Journal of Pediatric Cardiology and Cardiac Surgery

Background: The aim of this study is to determine how interruption of cardiologist follow-up affects pulmonary valve replacement (PVR) outcomes in patients with tetralogy of Fallot (TOF) who have previously undergone repair using a transannular patch.

Methods: Between 2007 and 2022, surgical PVR was performed in 15 repaired TOF patients. Patients were divided into 2 groups by without (Group 1, n=4) or with (Group 2, n=11) scheduled follow-up by a cardiology specialist. Preoperative characteristics and, peri-/post-operative outcomes were compared.

Results: In Group 1, the median age at PVR was older (p=0.004), the median interval from TOF repair to PVR was longer (p=0.004), pre-operative median cardio-thoracic ratio on chest-X ray was larger (p=0.022), and pre-operative median serum brain natriuretic peptide was higher (p=0.022). In Group 1, 3 out of 4 patients died within approximately one year after PVR, whereas no deaths occurred in Group 2. The number of concomitant procedures was significantly greater in Group 1 (p=0.001), intraoperative blood loss more (p=0.011), operation time longer (p=0.0003), and cardiopulmonary bypass time longer (p=0.013).

Conclusion: Repaired TOF patients who did not receive chronological follow-up by a cardiology specialist showed extremely poor prognostic outcomes after surgical PVR.