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.