3.2 Postoperative events and late reoperation
Twenty-three patients required delayed sternal closure, almost all of whom were treated during 2010-2014. Postoperative arrhythmia occurred in 24 patients (33%), including junctional ectopic tachycardia in 6 patients, supraventricular tachycardia in 3 patients, and sinus bradycardia in 15 patients, but no complete atrioventricular block. Nosocomial infection was one of the major complications in our series, with pneumonia in 17 patients, wound infection in 6 patients, sepsis in 5 patients, and a deep sternal wound infection in 1 patient.
There were 7 late reoperations in 5 patients, which included 5 reoperations for RVOTO in 3 patients during follow-up. One patient required pacemaker implantation due to sinus node dysfunction, and 1 patient developed ascending aorta stenosis after total correction for TBV with an interrupted aortic arch. One patient required balloon cardiac intervention for residual coarctation after the ASO with coarctation repair. Focusing on RVOTO, the median pressure gradient through the RVOT at the latest follow-up was 5 mmHg (IQR, 3 – 9). There were 2 patients with mild to moderate RVOTO (PG 28-35mmHg) only on echocardiography who may require reoperation in the future, but no symptoms were observed during exercise at the latest follow-up. No patients developed suprapulmonary stenosis or PA branch stenosis during follow-up. The latest echocardiogram revealed no or trivial neo-aortic valve regurgitation in 48 patients, and 2 patients had mild aortic regurgitation. The estimated freedom from RVOTO reoperation for this cohort at 1 year, 5 years and 9 years was 98.3% (SD=1.7) (95% CI, 0.8857 to 0.9976), 91.9% (SD=4.8) (95% CI, 0.7524 to 0.9749) and 91.9 (SD=4.8) (95% CI, 0.7524 to 0.9749), respectively (Figure 3).
Concerning the possibility of neo-PV growth, the diameter and the Z-score of the neo-PV in the subgroup of TBV associated with aortic arch anomalies was calculated preoperatively and at the last follow-up on echocardiography and showed significant growth (P < 0.001 and P = 0.001, respectively), as shown in Figure 4.