{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,13]],"date-time":"2026-06-13T14:09:48Z","timestamp":1781359788123,"version":"3.54.1"},"reference-count":24,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2020,3,18]],"date-time":"2020-03-18T00:00:00Z","timestamp":1584489600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Medical Research Council","award":["MR\/N0137941\/1"],"award-info":[{"award-number":["MR\/N0137941\/1"]}]},{"DOI":"10.13039\/100006662","name":"NIHR","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100006662","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Biomedical Research Centre at University Hospitals Bristol NHS Foundation Trust"},{"DOI":"10.13039\/501100000883","name":"University of Bristol","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000883","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000274","name":"British Heart Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000274","id-type":"DOI","asserted-by":"publisher"}]},{"name":"National Institute for Cardiovascular Outcomes Research"},{"name":"National Congenital Heart Disease Audit"},{"name":"Healthcare Quality Improvement Partnership"},{"name":"National Clinical Audit and Patient Outcomes Programme"},{"name":"National Health Service, UK"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,10,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p\/><jats:sec><jats:title>OBJECTIVES<\/jats:title><jats:p>Many adults with repaired tetralogy of Fallot will require a pulmonary valve replacement (PVR), but there is no consensus on the best timing. In this study, we aim to evaluate the impact of age at PVR on outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>This is a national multicentre retrospective study including all patients &amp;gt;15\u2009years of age with repaired tetralogy of Fallot who underwent their first PVR between 2000 and 2013. The optimal age cut-off was identified using Cox regression and classification and regression tree analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>A total of 707 patients were included, median age 26 (15\u201372) years. The mortality rate at 10\u2009years after PVR was 4.2%, and the second PVR rate of 6.8%. Age at PVR of 35\u2009years was identified as the optimal cut-off in relation to late mortality. Patients above 35\u2009years of age had a 5.6 fold risk of death at 10\u2009years compared with those with PVR under 35\u2009years (10.4% vs 1.3%, P\u2009&amp;lt;\u20090.001), more concomitant tricuspid valve repair\/replacement (15.1% vs 5.7%, P\u2009&amp;lt;\u20090.001) and surgical arrhythmia treatment (18.4% vs 5.9%, P\u2009&amp;lt;\u20090.001). In those under 50\u2009years, there was an 8.7 fold risk of late death compared with the general population, higher for those with PVR after 35 than those with PVR below 35\u2009years (hazard ratio 9.9 vs 7.4).<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>Patients above 35\u2009years of age with repaired tetralogy of Fallot have significantly worse mortality after PVR, compared with younger patients and a higher burden of mortality relative to the general population. This suggests that there are still cases where the timing of initial PVR is not optimal, warranting a re-evaluation of criteria for intervention.<\/jats:p><\/jats:sec>","DOI":"10.1093\/ejcts\/ezaa069","type":"journal-article","created":{"date-parts":[[2020,2,12]],"date-time":"2020-02-12T04:26:11Z","timestamp":1581481571000},"page":"825-831","source":"Crossref","is-referenced-by-count":16,"title":["Age over 35 years is associated with increased mortality after pulmonary valve replacement in repaired tetralogy of Fallot: results from the UK National Congenital Heart Disease Audit database"],"prefix":"10.1093","volume":"58","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2443-1019","authenticated-orcid":false,"given":"Dan M","family":"Dorobantu","sequence":"first","affiliation":[{"name":"School of Sport and Health Sciences, University of Exeter, Exeter, UK"},{"name":"Bristol Medical School, University of Bristol, Bristol, UK"},{"name":"Department of Cardiology, \u201cProf. C.C. Iliescu\u201d Institute of Cardiovascular Diseases, Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3808-277X","authenticated-orcid":false,"given":"Mansour T A","family":"Sharabiani","sequence":"additional","affiliation":[{"name":"Department of Primary Care & Public Health, School of Public Health, Imperial College of London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Demetris","family":"Taliotis","sequence":"additional","affiliation":[{"name":"Departments of Cardiology and Cardiac Surgery, The Heart Institute and Royal Hospital for Children, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew J","family":"Parry","sequence":"additional","affiliation":[{"name":"Departments of Cardiology and Cardiac Surgery, The Heart Institute and Royal Hospital for Children, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3180-6993","authenticated-orcid":false,"given":"Robert M R","family":"Tulloh","sequence":"additional","affiliation":[{"name":"Bristol Medical School, University of Bristol, Bristol, UK"},{"name":"Departments of Cardiology and Cardiac Surgery, The Heart Institute and Royal Hospital for Children, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James R","family":"Bentham","sequence":"additional","affiliation":[{"name":"Departments of Cardiology and Cardiac Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Massimo","family":"Caputo","sequence":"additional","affiliation":[{"name":"Bristol Medical School, University of Bristol, Bristol, UK"},{"name":"Departments of Cardiology and Cardiac Surgery, The Heart Institute and Royal Hospital for Children, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carin","family":"van Doorn","sequence":"additional","affiliation":[{"name":"Departments of Cardiology and Cardiac Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Serban C","family":"Stoica","sequence":"additional","affiliation":[{"name":"Bristol Medical School, University of Bristol, Bristol, UK"},{"name":"Departments of Cardiology and Cardiac Surgery, The Heart Institute and Royal Hospital for Children, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2020,3,18]]},"reference":[{"key":"2021031117392642100_ezaa069-B1","doi-asserted-by":"crossref","first-page":"1530","DOI":"10.12688\/f1000research.17174.1","article-title":"Current outcomes and treatment of tetralogy of Fallot","volume":"8","author":"van der 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