THE IMPACT OF PULMONIC VALVE REPLACEMENT ON VENTRICULAR ARRHYTHMIAS
ASSOCIATED WITH TETRALOGY OF FALLOT PATIENTS
Abstract
Background: There is no consensus on the timing of pulmonary valve
replacement (PVR) in these patients or the impact of PVR on the
subsequent development of fatal arrhythmias such as ventricular
tachycardia. We have assessed the incidence of ventricular arrhythmias
in patients with PVR versus those without PVR in patients with TOF.
Methods: We performed an aggregate data meta-analysis on 12 studies with
1,740 patients on the development of ventricular arrhythmias following
initial repair, comparing patients who had PVR years after initial
repair versus those who had no further intervention. We also performed a
meta-regression analysis to evaluate the effect of preoperative and
postoperative right ventricular end-diastolic volume (RV-EDV) and QRS on
the incidence of ventricular arrhythmias. Results: Among 1,740 patients
with TOF, ventricular arrhythmias in patients with PVR were reduced by
almost 60% than patients without PVR (OR 0.40, 95% CI 0.219-0.725, p
<0.003). Similar results were noted in both fixed- and
random-effects models. The standardized difference in means for RV-EDV
after PVR showed a statistically significant reduction after PVR
(random-effects model: -1.44, SE = 0.188, p < 0.0001).
Patients also had a statistically significant increase in RV-EF and
reduction QRS as well as increase in RV-EF following PVR. Neither
pre-operative RV-EDV nor QRS duration was associated with statistically
significant coefficients for changes in the incidence of VT by
meta-regression. Conclusion: For TOF survivors after repair, there was a
markedly reduced rate of ventricular arrhythmias in patients who
received PVR compared to patients without PVR.