Results:
Between January 2000 and December 2017, 107 had PH implantation for RVOT reconstruction. Patient’s baseline characteristics are summarized in table 1. Mean age of the recipients was 26.13 ± 13.59 years. Most of recipient blood types were O-type and A-type (38.3% and 43.9%), and Rhesus positive for 91 patients (85.0%). The most common primary congenital heart disease was the Tetralogy of Fallot (TOF) (69 patients, 64.5%). Redo surgery was performed in 101 patients (94.4%). Primary surgery was performed during childhood and growth either to correct a congenital heart disease (surgical correction of Tetralogy of Fallot, pulmonary atresia, truncus arteriosus, Rastelli operation, RV-PA conduit implantation, arterial switch, REV technique, surgical closure of a septal or atrial septal defect, surgical pulmonary valvuloplasty), or to perform palliative techniques (Blalock-Taussig, central shunt). Some primary congenital heart diseases were associated at initial diagnosis (table 1): 4 patients had transposition of the great arteries (TGA) + ventricular septal defect (VSD) + pulmonary stenosis (PS), 1 patient had TGA + PS, 1 patient with Ebstein disease + PS, 4 patients had VSD + PS, 1 patient had a double outlet right ventricle + pulmonary stenosis, 1 patient had TOF + agenesia of the pulmonary valve, 2 patients had TGA + VSD. Mean age of the donors was 48.78 ± 11.29 years. ABO and Rhesus compatibility between recipient and donors was observed in 30 implantations of PH (28.0%). Isolated ABO compatibility and isolated Rhesus compatibility were respectively observed in 41 (38.3%) and 80 (74.8%) PH implantations. Mean size of the implanted PH was 23.02 ± 6.87 mm.
Operative characteristics are summarized in table 2. Indications for PH implantation were: pulmonary regurgitation (PR) (68.2%), pulmonary stenosis (PS) (25.2%), pulmonary endocarditis (5.6%) and changing PH during other cardiac surgery (0.9%). Among patients who underwent PH implantation for pulmonary regurgitation, 59 patients (80.8%) had previous surgical correction of a TOF, 4 patients (5.5%) had surgical a previous surgical treatment of pulmonary atresia, 1 patient (1.3%) had previous surgical correction of TOF + pulmonary agenesia, 7 patients (9.6%) had previous surgical treatment of a PS (3 commissuroplasty, 4 RV-PA conduit) and 2 patients (2.7%) had surgical correction of a double outlet right ventricle. Among patients who had PH implantation for PS, 8 patients (29.6%) had previous surgical treatment of truncus arteriosus, 5 patients (18.5%) had surgical correction for TOF, 5 patients (18.5%) had surgical treatment of transposition of the great arteries (TGA) + ventricular septal defect + PS, 1 patient (3.7%) was operated from TGA + VSD, 1 patient (3.7%) was operated from TGA + PS, 5 patients (18.5%) had previous surgical treatment of pulmonary atresia, 1 patient (3.7%) had surgical correction of aortic stenosis and 1 patient (3.7%) was operated from Ebstein disease + PS. Cross-clamping during PH implantation was performed for 89 patients (83.1%) and 18 patients (16.8%) had no cross-clamping during PH implantation. Multiple concomitant surgical procedures were performed in 43 patients (39.8%). Concomitant tricuspid valve surgery occurred in 23 (21.5%) patients (1 tricuspid valve replacement, 22 tricuspid valve repair). Atrial and ventricular surgeries were associated to PH implantation in 11 patients (10.2%). Of them, 5 patients (4.6%) had correction of an atrial septal defect (ASD), 2 (1.8%) patients had correction of VSD, and 2 (1.5%) patients had REV procedure. Surgical enlargement of the pulmonary arteries for pulmonary stenosis was performed in 10 (9.3%) patients. Concerning the overall survival of patients implanted with a PH (table 3): in-hospital mortality was 4.6%. Five patients died during the early postoperative period. Among these patients, 2 of them died from heart failure (1 acute pulmonary edema, 1 severe right ventricle dysfunction caused by pulmonary hypertension), 1 died from sudden ventricular fibrillation, 1 died from respiratory failure and 1 died from acute liver failure. No death occurred during long-term follow-up. Mean follow-up interval was 4.68 ± 4.28 years (median (interquartile range): 2.99 years (6.19)). Overall survival during follow-up at 1, 5 and 10 years was 95.2%.