Perioperative management and outcomes of surgical pulmonary valve replacement following tetralogy of fallot repair: A retrospective study.

BACKGROUND

While the long-term prognosis of Tetralogy of Fallot (TOF) repair is favourable, the frequency of interventions for pulmonary valve insufficiency during follow-up remains high, raising concerns regarding its invasiveness. This study aimed to evaluate the safety measures and strategies for the perioperative management of pulmonary valve interventions following TOF repair.

METHODS

From November 2022 to December 2023, interventions in the pulmonary artery for TOF were performed in 17 patients; a retrospective analysis was conducted on all patients. Preoperative haemodynamic evaluation was performed using 4D-flow magnetic resonance imaging in all cases.

RESULTS

The 17 patients included in the study had a mean age of 24.1 ± 14 years. The mean duration from repair to re-intervention was 18.2 ± 12 years, with a preoperative right ventricular ejection fraction of 42.3 ± 12 %. The mean surgical time, cardiopulmonary bypass time, and aortic cross-clamp time were 389 ± 96, 210 ± 67, and 106 ± 48 min, respectively. Pulmonary valve replacement was performed in eight patients, with seven using porcine aortic valves and one using a bovine pericardial valve. The Rastelli-type procedure was performed in nine cases, with seven using expanded polytetrafluoroethylene valved conduits and two using composite grafts of a porcine bioprosthetic valve and Valsalva graft. Additional procedures included right ventricular outflow tract myectomy in nine patients, pulmonary artery reconstruction in five, cryoablation in four, coronary artery bypass grafting in three, tricuspid valve repair in three, and ventricular septal defect closure in one. There were no cases of early mortality, stroke, or re-operation within 30 days.

CONCLUSION

Interventions on the pulmonary valves following TOF repair can be safely performed with appropriate perioperative management. The primary goal of surgical pulmonary valve replacement is to preserve the right ventricular function and reconstruct a smooth pathway from the right ventricle to the pulmonary artery, considering future transcatheter interventions. Further long-term follow-up is necessary to assess outcomes, such as remote mortality, right ventricular function, and arrhythmia occurrence.