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Progress of valve-sparing repair strategies in the treatment of tetralogy of Fallot

Published online by Cambridge University Press:  10 October 2025

Zhangwei Wang Open the ORCID record for Zhangwei Wang [Opens in a new window] ,
Honghao Fu  and
Shoujun Li
Zhangwei Wang
Affiliation:
Department of Cardiovascular Surgery, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Fuwai Hospital, Xicheng District, Beijing, China
Honghao Fu
Affiliation:
Department of Cardiovascular Surgery, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Fuwai Hospital, Xicheng District, Beijing, China
Shoujun Li*
Affiliation:
Department of Cardiovascular Surgery, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Fuwai Hospital, Xicheng District, Beijing, China
*
Corresponding author: Shoujun Li; Email: beijing348@qq.com
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Abstract

In the past few decades, long-term basic research and clinical practice of surgical treatment for tetralogy of Fallot have been carried out at home and abroad, and the treatment effect has been improved, the complications and mortality have been gradually decreased. Pulmonary regurgitation is a common complication after traditional radical repair of tetralogy of Fallot, which is an important factor leading to many adverse outcomes. Valve-sparing repair has gradually become the first choice for the treatment of tetralogy of Fallot, which can effectively prevent the occurrence of postoperative pulmonary regurgitation, maintain right ventricular function, and improve the prognosis of children. However, there are controversies about the application indications and surgical strategies of valve-sparing repair, and a lack of clear clinical guidelines. This article reviews the research progress on the advantages, surgical indications, surgical techniques, prognosis and prospects of valve-sparing repair for tetralogy of Fallot, in order to provide evidence-based medical evidence for when to undergo valve-sparing repair for tetralogy of Fallot patients and to better improve the quality of life of patients.

Keywords

Tetralogy of fallotvalve-sparing repairindicationsprogress

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Type
Review
Information
Cardiology in the Young , First View , pp. 1 - 10
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Copyright
© The Author(s), 2025. Published by Cambridge University Press

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Footnotes

Zhangwei Wang and Honghao Fu contributed equally to this work.

References

Huishan, Wang, Shoujun, Li. Representatives of national society for congenital heart disease. Chinese expert consensus on surgical treatment of congenital heart disease (10): tetralogy of fallot. Chinese J Clin Thorac Cardiovasc Surg 2020; 27 : 1247–1254.Google Scholar
LILLEHEI, CW, COHEN, M, WARDEN, HE, et al. Direct vision intracardiac surgical correction of the tetralogy of fallot, pentalogy of fallot, and pulmonary atresia defects; report of first ten cases. Ann Surg 1955; 142: 418–442.10.1097/00000658-195509000-00010CrossRefGoogle ScholarPubMed
Ishigami, S, Ye, XT, Buratto, E, et al. Long-term outcomes of tetralogy of fallot repair: a 30-year experience with 960 patients. J Thorac Cardiov Sur 2024; 167: 289–302.10.1016/j.jtcvs.2023.04.015CrossRefGoogle ScholarPubMed
Vanderlaan, RD, Barron, DJ. Optimal Surgical Management of Tetralogy of Fallot. CJC Pediatr Congenit Heart Dis 2023; 2: 352–360.10.1016/j.cjcpc.2023.09.003CrossRefGoogle ScholarPubMed
Mouws, E, de Groot, N, van de Woestijne, PC, et al. Tetralogy of Fallot in the Current Era. Semin Thorac Cardiov 2019; 31: 496–504.10.1053/j.semtcvs.2018.10.015CrossRefGoogle ScholarPubMed
Smith, CA, McCracken, C, Thomas, AS, et al. Long-term outcomes of tetralogy of fallot: a study from the pediatric cardiac care consortium. Jama Cardiol 2019; 4: 34–41.10.1001/jamacardio.2018.4255CrossRefGoogle ScholarPubMed
Sinha, R, Gooty, V, Jang, S, Dodge-Khatami, A, Salazar, J. Validity of pulmonary valve Z-scores in predicting valve-sparing tetralogy repairs-systematic review. Children (Basel) 2019; 6: 67.Google ScholarPubMed
Miller, JR, Stephens, EH, Goldstone, AB, et al. The American Association for Thoracic Surgery (AATS) 2022 expert consensus document: management of infants and neonates with tetralogy of fallot. J Thorac Cardiov Sur 2023; 165: 221–250.10.1016/j.jtcvs.2022.07.025CrossRefGoogle Scholar
Sen, DG, Najjar, M, Yimaz, B, et al. Aiming to preserve pulmonary valve function in tetralogy of fallot repair: comparing a new approach to traditional management. Pediatr Cardiol 2016; 37: 818–825.10.1007/s00246-016-1355-1CrossRefGoogle ScholarPubMed
Hickey, E, Pham-Hung, E, Halvorsen, F, et al. Annulus-sparing tetralogy of fallot repair: low risk and benefits to right ventricular geometry. Ann Thorac Surg 2018; 106: 822–829.10.1016/j.athoracsur.2017.11.032CrossRefGoogle ScholarPubMed
Arafat, AA, Elatafy, EE, Elshedoudy, S, Zalat, M, Abdallah, N, Elmahrouk, A. Surgical strategies protecting against right ventricular dilatation following tetralogy of fallot repair. J Cardiothorac Surg 2018; 13: 14.10.1186/s13019-018-0702-0CrossRefGoogle ScholarPubMed
Yi, K, Wang, D, Xu, J, et al. Surgical strategies for preservation of pulmonary valve function in a radical operation for tetralogy of fallot: a systematic review and meta-analysis. Front Cardiovasc Med 2022; 9: 888258.10.3389/fcvm.2022.888258CrossRefGoogle Scholar
Bacha, E. Valve-sparing or valve reconstruction options in tetralogy of fallot surgery. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2017; 20: 79–83.10.1053/j.pcsu.2016.09.001CrossRefGoogle ScholarPubMed
Hoashi, T, Kagisaki, K, Meng, Y, et al. Long-term outcomes after definitive repair for tetralogy of fallot with preservation of the pulmonary valve annulus. J Thorac Cardiov Sur 2014; 148: 802–808. 808–809.10.1016/j.jtcvs.2014.06.008CrossRefGoogle ScholarPubMed
Lozano-Balseiro, M, Garcia-Vieites, M, Martinez-Bendayan, I, et al. Valve-Sparing Tetralogy of Fallot Repair With Intraoperative Dilation of the Pulmonary Valve. Mid-Term Results. Semin Thorac Cardiov 2019; 31: 828–834.10.1053/j.semtcvs.2019.04.007CrossRefGoogle ScholarPubMed
Sorabella, R, Si, MS. Commentary: valve-sparing approach to the hypoplastic pulmonary valve in tetralogy of fallot repair. J Thorac Cardiov Sur 2019; 158: e57–e58.10.1016/j.jtcvs.2019.02.033CrossRefGoogle Scholar
D’Udekem, Y, Galati, JC, Rolley, GJ, et al. Low risk of pulmonary valve implantation after a policy of transatrial repair of tetralogy of fallot delayed beyond the neonatal period: the Melbourne experience over 25 years. J Am Coll Cardiol 2014; 63: 563–568.10.1016/j.jacc.2013.10.011CrossRefGoogle ScholarPubMed
Kirklin, JK, Kirklin, JW, Pacifico, AD. Transannular outflow tract patching for tetralogy: indications and results. Semin Thorac Cardiov 1990; 2: 61–69.Google Scholar
Choi, SJ, Kwon, JE, Roh, DE, et al. Importance of pulmonary valve morphology for pulmonary valve preservation in tetralogy of fallot surgery: comparison of the echocardiographic parameters. Clin Exp Pediatr 2020; 63: 189–194.10.3345/kjp.2019.01060CrossRefGoogle ScholarPubMed
Awori, MN, Mehta, NP, Mitema, FO, Kebba, N. Optimal use of Z-scores to preserve the pulmonary valve annulus during repair of tetralogy of fallot. World J Pediatr Cong 2018; 9: 285–288.Google ScholarPubMed
Wang, Z, Li, Z, Ding, N, Zhu, Y, Li, X, Yi, H. When do patients with tetralogy of fallot need a transannular patch. J Cardiac Surg 2022; 37: 5041–5051.10.1111/jocs.17191CrossRefGoogle Scholar
Lyu, Z, Jin, M, Yang, Y. Value of pulmonary annulus index in predicting transannular patch in tetralogy of fallot repair. J Cardiac Surg 2021; 36: 2197–2203.10.1111/jocs.15500CrossRefGoogle ScholarPubMed
Stellin, G, Guariento, A, Vida, VL. Evolving techniques for the achievement of optimal long-term results after tetralogy of fallot repair. World J Pediatr Cong 2021; 12: 116–123.Google ScholarPubMed
Guariento, A, Schiena, CA, Cattapan, C, et al. Pulmonary valve preservation during tetralogy of fallot repair: midterm functional outcomes and risk factors for pulmonary regurgitation. Eur J Cardiothorac Surg 2022; 62: ezac365.10.1093/ejcts/ezac365CrossRefGoogle ScholarPubMed
Pettersen, MD, Du, W, Skeens, ME, Humes, RA. Regression equations for calculation of z scores of cardiac structures in a large cohort of healthy infants, children, and adolescents: an echocardiographic study. J Am Soc Echocardiog 2008; 21: 922–934.10.1016/j.echo.2008.02.006CrossRefGoogle Scholar
Choi, KH, Sung, SC, Kim, H, et al. A novel predictive value for the transannular patch enlargement in repair of tetralogy of fallot. Ann Thorac Surg 2016; 101: 703–707.10.1016/j.athoracsur.2015.10.050CrossRefGoogle ScholarPubMed
Kasturi, S, Balaji, S, Sudhakar, A, et al. Accuracy of a new echocardiographic index to predict need for trans-annular patch in tetralogy of fallot. Pediatr Cardiol 2019; 40: 161–167.10.1007/s00246-018-1973-xCrossRefGoogle ScholarPubMed
Zhao, J, Cai, X, Teng, Y, et al. Value of pulmonary annulus area index in predicting transannular patch placement in tetralogy of fallot repair. J Cardiac Surg 2020; 35: 48–53.10.1111/jocs.14321CrossRefGoogle ScholarPubMed
Xiao-wei, Cai, Jun-fei, Zhao, Xiao-bing, Liu, et al. Proportion of pulmonary valve annulus: a new predictive index for transannular patch in repair of tetralogy of fallot. Chinese J Clin Thorac Cardiovasc Surg 2019; 26 : 316–320.Google Scholar
Siddiqi, U, Adewale, A, Pena, E, et al. Preserving the pulmonary valve in tetralogy of fallot repair: reconsidering the indication for valve-sparing. J Cardiac Surg 2022; 37: 5144–5152.10.1111/jocs.17156CrossRefGoogle ScholarPubMed
Bacha, E. Valve-sparing options in tetralogy of fallot surgery. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2012; 15: 24–26.10.1053/j.pcsu.2012.01.006CrossRefGoogle ScholarPubMed
Hofferberth, SC, Nathan, M, Marx, GR, et al. Valve-sparing repair with intraoperative balloon dilation in tetralogy of fallot: midterm results and therapeutic implications. J Thorac Cardiov Sur 2018; 155: 1163–1173.10.1016/j.jtcvs.2017.08.147CrossRefGoogle ScholarPubMed
Sluysmans, T, Neven, B, Rubay, J, et al. Early balloon dilatation of the pulmonary valve in infants with tetralogy of fallot. Risks and benefits. Circulation 1995; 91: 1506–1511.10.1161/01.CIR.91.5.1506CrossRefGoogle ScholarPubMed
Bautista-Hernandez, V, Cardenas, I, Martinez-Bendayan, I, Loyola, H, Rueda, F, Portela, F. Valve-sparing tetralogy of fallot repair with intraoperative dilation of the pulmonary valve. Pediatr Cardiol 2013; 34: 918–923.10.1007/s00246-012-0574-3CrossRefGoogle ScholarPubMed
Patukale, A, Daley, M, Betts, K, et al. Outcomes of pulmonary valve leaflet augmentation for transannular repair of tetralogy of fallot. J Thorac Cardiov Sur 2021; 162: 1313–1320.10.1016/j.jtcvs.2020.12.145CrossRefGoogle ScholarPubMed
Dharmapuram, AK, Ramadoss, N, Goutami, V, Verma, S, Pande, S, Devalaraja, S. Early experience with surgical strategies aimed at preserving the pulmonary valve and annulus during repair of tetralogy of Fallot. Ann Pediat Cardiol 2021; 14: 315–322.10.4103/apc.APC_166_20CrossRefGoogle ScholarPubMed
Vida, VL, Angelini, A, Guariento, A, et al. Preserving the pulmonary valve during early repair of tetralogy of fallot: anatomic substrates and surgical strategies. J Thorac Cardiov Sur 2015; 149: 1358–1363.10.1016/j.jtcvs.2015.01.030CrossRefGoogle ScholarPubMed
Turkoz, R, Dogan, A, Oktay, A, Saygili, A. Valve-sparing repair with skeletonization of the pulmonary annulus for tetralogy of fallot. J Cardiac Surg 2019; 34: 1626–1628.10.1111/jocs.14252CrossRefGoogle ScholarPubMed
Schulte, LJ, Miller, PC, Bhat, AN, et al. Evolution of pulmonary valve management during repair of tetralogy of fallot: a 14-year experience. Ann Thorac Surg 2023; 115: 462–469.10.1016/j.athoracsur.2022.05.063CrossRefGoogle ScholarPubMed
Amirghofran, A, Edraki, F, Edraki, M, et al. Surgical repair of tetralogy of fallot using autologous right atrial appendages: short- to mid-term results. Eur J Cardio-Thorac 2021; 59: 697–704.10.1093/ejcts/ezaa374CrossRefGoogle ScholarPubMed
Egunov, OA, Kozhanov, RS, Cetta, F, Krivoshchekov, EV. Surgical repair of tetralogy of fallot using autologous right atrial appendage to reconstruct the right ventricular outflow tract: a case series with four-year follow-up. World J Pediatr Cong 2024; 15: 861–863.Google ScholarPubMed
Bertranou, EG, Blackstone, EH, Hazelrig, JB, Turner, ME, Kirklin, JW. Life expectancy without surgery in tetralogy of fallot. Am J Cardiol 1978; 42: 458–466.10.1016/0002-9149(78)90941-4CrossRefGoogle ScholarPubMed
Cuypers, JA, Menting, ME, Konings, EE, et al. Unnatural history of tetralogy of fallot: prospective follow-up of 40 years after surgical correction. Circulation 2014; 130: 1944–1953.10.1161/CIRCULATIONAHA.114.009454CrossRefGoogle ScholarPubMed
Robinson, JD, Rathod, RH, Brown, DW, et al. The evolving role of intraoperative balloon pulmonary valvuloplasty in valve-sparing repair of tetralogy of fallot. J Thorac Cardiov Sur 2011; 142: 1367–1373.10.1016/j.jtcvs.2011.02.047CrossRefGoogle ScholarPubMed
Wei, X, Li, T, Ling, Y, et al. Transannular patch repair of tetralogy of fallot with or without monocusp valve reconstruction: a meta-analysis. Bmc Surg 2022; 22: 18.10.1186/s12893-022-01474-6CrossRefGoogle ScholarPubMed
Sasikumar, D, Sasidharan, B, Tharakan, JA, Dharan, BS, Mathew, T, Karunakaran, J. Early and 1-year outcome and predictors of adverse outcome following monocusp pulmonary valve reconstruction for patients with tetralogy of fallot: a prospective observational study. Ann Pediat Cardiol 2014; 7: 5–12.10.4103/0974-2069.126538CrossRefGoogle ScholarPubMed
Turrentine, MW, McCarthy, RP, Vijay, P, McConnell, KW, Brown, JW. PTFE monocusp valve reconstruction of the right ventricular outflow tract. Ann Thorac Surg 2002; 73: 871–879. 879–880.10.1016/S0003-4975(01)03441-5CrossRefGoogle ScholarPubMed
Vogt, PR, Genoni, M, Kunzli, A, Turina, MI. Cryopreserved homograft monocusp valves for reconstruction of the right ventricular outflow tract. J Thorac Cardiov Sur 1997; 113: 423.10.1016/S0022-5223(97)70345-3CrossRefGoogle ScholarPubMed
Vacanti, JP, Morse, MA, Saltzman, WM, Domb, AJ, Perez-Atayde, A, Langer, R. Selective cell transplantation using bioabsorbable artificial polymers as matrices. J Pediatr Surg 1988; 23: 3–9.10.1016/S0022-3468(88)80529-3CrossRefGoogle ScholarPubMed
Langer, R, Vacanti, J. Advances in tissue engineering. J Pediatr Surg 2016; 51: 8–12.10.1016/j.jpedsurg.2015.10.022CrossRefGoogle ScholarPubMed
Tomsic, A, Bissessar, DD, van Brakel, TJ, Marsan, NA, Klautz, R, Palmen, M. Initial experience and early results of mitral valve repair with cardioCel pericardial patch. Ann Thorac Surg 2018; 106: 1241–1244.10.1016/j.athoracsur.2018.04.086CrossRefGoogle ScholarPubMed
Pavy, C, Michielon, G, Robertus, JL, Lacour-Gayet, F, Ghez, O. Initial 2-year results of CardioCel(R) patch implantation in children. Interact Cardiov Th 2018; 26: 448–453.Google Scholar
D’Udekem, Y, Galati, JC, Konstantinov, IE, Cheung, MH, Brizard, CP. Intersurgeon variability in long-term outcomes after transatrial repair of tetralogy of fallot: 25 years’ experience with 675 patients. J Thorac Cardiov Sur 2014; 147: 880–886.10.1016/j.jtcvs.2013.11.010CrossRefGoogle ScholarPubMed
Park, CS, Lee, JR, Lim, HG, Kim, WH, Kim, YJ. The long-term result of total repair for tetralogy of fallot. Eur J Cardio-Thorac 2010; 38: 311–317.10.1016/j.ejcts.2010.02.030CrossRefGoogle ScholarPubMed