{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T02:13:40Z","timestamp":1790216020654,"version":"4.1.0"},"reference-count":45,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[2014,1,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background\u2014<\/jats:title>\n                    <jats:p>Indications for surgical pulmonary valve replacement (PVR) after repair of tetralogy of Fallot have recently been broadened to include asymptomatic patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and Results\u2014<\/jats:title>\n                    <jats:p>\n                      The outcomes of PVR in adults after repair of tetralogy of Fallot at a single tertiary center were retrospectively studied. Preoperative cardiopulmonary exercise testing was included. Mortality was the primary outcome measure. In total, 221 PVRs were performed in 220 patients (130 male patients; median age, 32 years; range, 16\u201364 years). Homografts were used in 117 patients, xenografts in 103 patients, and a mechanical valve in 1 patient. Early (30-day) mortality was 2%. Overall survival was 97% at 1 year, 96% at 3 years, and 92% at 10 years. Survival after PVR in the later era (2005\u20132010; n=156) was significantly better compared with survival in the earlier era (1993\u20132004; n=65; 99% versus 94% at 1 year and 98% versus 92% at 3 years, respectively;\n                      <jats:italic>P<\/jats:italic>\n                      =0.019). Earlier era patients were more symptomatic preoperatively (\n                      <jats:italic>P<\/jats:italic>\n                      =0.036) with a lower preoperative peak oxygen consumption (peak\n                      <jats:inline-graphic xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"18eq01.jpeg\"\/>\n                      <jats:sc>o<\/jats:sc>\n                      <jats:sub>2<\/jats:sub>\n                      ;\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.001). Freedom from redo surgical or transcatheter PVR was 98% at 5 years and 96% at 10 years for the whole cohort. Peak\n                      <jats:inline-graphic xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"18eq02.jpeg\"\/>\n                      <jats:sc>o<\/jats:sc>\n                      <jats:sub>2<\/jats:sub>\n                      , E\/CO2 slope (ratio of minute ventilation to carbon dioxide production), and heart rate reserve during cardiopulmonary exercise testing predicted risk of early mortality when analyzed with logistic regression analysis; peak\n                      <jats:inline-graphic xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"18eq03.jpeg\"\/>\n                      <jats:sc>o<\/jats:sc>\n                      <jats:sub>2<\/jats:sub>\n                      emerged as the strongest predictor on multivariable analysis (odds ratio, 0.65 per 1 mL\u00b7kg\n                      <jats:sup>\u22121<\/jats:sup>\n                      \u00b7min\n                      <jats:sup>\u22121<\/jats:sup>\n                      ;\n                      <jats:italic>P<\/jats:italic>\n                      =0.041).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions\u2014<\/jats:title>\n                    <jats:p>PVR after repair of tetralogy of Fallot has a low and improving mortality, with a low need for reintervention. Preoperative cardiopulmonary exercise testing predicts surgical outcome and should therefore be included in the routine assessment of these patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circulationaha.113.001485","type":"journal-article","created":{"date-parts":[[2013,10,21]],"date-time":"2013-10-21T22:14:32Z","timestamp":1382393672000},"page":"18-27","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":178,"title":["Clinical Outcomes of Surgical Pulmonary Valve Replacement After Repair of Tetralogy of Fallot and Potential Prognostic Value of Preoperative Cardiopulmonary Exercise Testing"],"prefix":"10.1161","volume":"129","author":[{"given":"Sonya V.","family":"Babu-Narayan","sequence":"first","affiliation":[{"name":"From the Royal Brompton and Harefield NHS Foundation Trust, London, UK (S.V.B.-N., G.-P.D., R.R.G., A.J.B., T.K., W.L., D.J.P., H.U., B.S., M.A.G., D.F.S.); and National Heart and Lung Institute, Imperial College London and NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and Imperial College London, London, UK (S.V.B.-N., W.L., D.J.P., M.A.G., D.F.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerhard-Paul","family":"Diller","sequence":"additional","affiliation":[{"name":"From the Royal Brompton and Harefield NHS Foundation Trust, London, UK (S.V.B.-N., G.-P.D., R.R.G., A.J.B., T.K., W.L., D.J.P., H.U., B.S., M.A.G., D.F.S.); and National Heart and Lung Institute, Imperial College London and NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and Imperial College London, London, UK (S.V.B.-N., W.L., D.J.P., M.A.G., D.F.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Radu R.","family":"Gheta","sequence":"additional","affiliation":[{"name":"From the Royal Brompton and Harefield NHS Foundation Trust, London, UK (S.V.B.-N., G.-P.D., R.R.G., A.J.B., T.K., W.L., D.J.P., H.U., B.S., M.A.G., D.F.S.); and National Heart and Lung Institute, Imperial College London and NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and Imperial College London, London, UK (S.V.B.-N., W.L., D.J.P., M.A.G., D.F.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony J.","family":"Bastin","sequence":"additional","affiliation":[{"name":"From the Royal Brompton and Harefield NHS Foundation Trust, London, UK (S.V.B.-N., G.-P.D., R.R.G., A.J.B., T.K., W.L., D.J.P., H.U., B.S., M.A.G., D.F.S.); and National Heart and Lung Institute, Imperial College London and NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and Imperial College London, London, UK (S.V.B.-N., W.L., D.J.P., M.A.G., D.F.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theodoros","family":"Karonis","sequence":"additional","affiliation":[{"name":"From the Royal Brompton and Harefield NHS Foundation Trust, London, UK (S.V.B.-N., G.-P.D., R.R.G., A.J.B., T.K., W.L., D.J.P., H.U., B.S., M.A.G., D.F.S.); and National Heart and Lung Institute, Imperial College London and NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and Imperial College London, London, UK (S.V.B.-N., W.L., D.J.P., M.A.G., D.F.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Li","sequence":"additional","affiliation":[{"name":"From the Royal Brompton and Harefield NHS Foundation Trust, London, UK (S.V.B.-N., G.-P.D., R.R.G., A.J.B., T.K., W.L., D.J.P., H.U., B.S., M.A.G., D.F.S.); and National Heart and Lung Institute, Imperial College London and NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and Imperial College London, London, UK (S.V.B.-N., W.L., D.J.P., M.A.G., D.F.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dudley J.","family":"Pennell","sequence":"additional","affiliation":[{"name":"From the Royal Brompton and Harefield NHS Foundation Trust, London, UK (S.V.B.-N., G.-P.D., R.R.G., A.J.B., T.K., W.L., D.J.P., H.U., B.S., M.A.G., D.F.S.); and National Heart and Lung Institute, Imperial College London and NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and Imperial College London, London, UK (S.V.B.-N., W.L., D.J.P., M.A.G., D.F.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hideki","family":"Uemura","sequence":"additional","affiliation":[{"name":"From the Royal Brompton and Harefield NHS Foundation Trust, London, UK (S.V.B.-N., G.-P.D., R.R.G., A.J.B., T.K., W.L., D.J.P., H.U., B.S., M.A.G., D.F.S.); and National Heart and Lung Institute, Imperial College London and NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and Imperial College London, London, UK (S.V.B.-N., W.L., D.J.P., M.A.G., D.F.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Babulal","family":"Sethia","sequence":"additional","affiliation":[{"name":"From the Royal Brompton and Harefield NHS Foundation Trust, London, UK (S.V.B.-N., G.-P.D., R.R.G., A.J.B., T.K., W.L., D.J.P., H.U., B.S., M.A.G., D.F.S.); and National Heart and Lung Institute, Imperial College London and NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and Imperial College London, London, UK (S.V.B.-N., W.L., D.J.P., M.A.G., D.F.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael A.","family":"Gatzoulis","sequence":"additional","affiliation":[{"name":"From the Royal Brompton and Harefield NHS Foundation Trust, London, UK (S.V.B.-N., G.-P.D., R.R.G., A.J.B., T.K., W.L., D.J.P., H.U., B.S., M.A.G., D.F.S.); and National Heart and Lung Institute, Imperial College London and NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and Imperial College London, London, UK (S.V.B.-N., W.L., D.J.P., M.A.G., D.F.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Darryl F.","family":"Shore","sequence":"additional","affiliation":[{"name":"From the Royal Brompton and Harefield NHS Foundation Trust, London, UK (S.V.B.-N., G.-P.D., R.R.G., A.J.B., T.K., W.L., D.J.P., H.U., B.S., M.A.G., D.F.S.); and National Heart and Lung Institute, Imperial College London and NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and Imperial College London, London, UK (S.V.B.-N., W.L., D.J.P., M.A.G., 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