Residual Pulmonary Valve Disease Following Repair of Tetralogy of Fallot—Is Stenosis Better Than Regurgitation?

Background: Residual pulmonary valve disease (PVD) including pulmonary stenosis (PS), pulmonary regurgitation (PR), or both remains a known complication following repair of Tetralogy of Fallot (TOF). We sought to clarify prevalence, progression, and prognostic impact of residual PVD. Methods: We identified consecutive patients who underwent repair of TOF at our institution between January 2004 and July 2023. Based on echocardiographic measurements following repair, residual PVD was defined: nonsevere PVD (PS < 25 mm Hg; PR<Grade3), isolated PS (PS ≥ 25 mm Hg; PR<Grade3), isolated PR (PS < 25 mm Hg; PR ≥ Grade3), and mixed PVD (PS ≥ 25 mm Hg; PR ≥ Grade3). Primary study endpoint was the composite of reoperation and catheter-based reintervention. Results: A total of 244 patients (median age 6 months) were included. Mean follow-up time was 9 ± 5 years. At discharge, 54 patients (23%) showed nonsevere PVD, PS (n = 62, 26%), PR (n = 63, 26%), or mixed PVD (n = 61, 25%). Freedom from primary endpoint was 92 ± 2% and 88 ± 2% at 5 and 10 years, respectively for all patients with residual PVD. There was no significant difference between patients with PS and PR at 10 years (PS, 86 ± 5% vs PR, 93 ± 4%; log-rank test, P =.85). Multivariable analysis demonstrated a significant association between mixed PVD and the primary study endpoint. Conclusion: Although residual PVD was frequent in patients following TOF repair, freedom from reintervention and reoperation was acceptable at midterm. Residual PS did not protect from reoperation or reintervention when compared with residual PR. The combination of PS and PR was identified as a risk factor for reoperation and reintervention.