Right Ventricular Diastolic Function Predicts Adverse Outcomes After Pulmonary Valve Replacement in Patients With...

The optimal timing of pulmonary valve replacement (PVR) in repaired tetralogy of Fallot (TOF) remains debated. We examined the influence of right ventricular (RV) diastolic dysfunction on post-PVR outcomes and investigated whether age ≥35 years at PVR is universally associated with adverse outcomes or represents a risk factor only in specific patient subgroups.

We reviewed 81 patients who underwent PVR for repaired TOF at Osaka University between 2002 and 2022. Adverse outcomes were defined as catheter ablation or pacemaker implantation for arrhythmia, or unplanned hospitalization for heart failure. RV diastolic dysfunction was defined as RV end-diastolic pressure ≥12 mmHg and/or a right atrial (RA) volume index ≥83 mL/m². Cox regression analysis was used to identify factors associated with adverse outcomes, with subgroup analyses stratified by the presence or absence of RV diastolic dysfunction. Adverse outcomes occurred in 24 patients (30%). The RA volume index was the only independently significant predictor of adverse outcomes. Age ≥35 years at PVR was significantly associated with reduced freedom from adverse events, but only in patients with RV diastolic dysfunction.

RV diastolic dysfunction was significantly associated with post-PVR clinical outcomes. Age ≥35 years at PVR was a significant risk factor only in patients with RV diastolic dysfunction, but not in those without, suggesting that advanced age alone does not uniformly confer increased risk.