Mild Residual Pulmonary Stenosis in Tetralogy of Fallot Reduces Risk of Pulmonary Valve Replacement

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Current surgical strategies that aim at preventing pulmonary regurgitation in patients with corrected tetralogy of Fallot (cToF) may result in a certain grade of residual pulmonary stenosis (PS). The clinical implications of a postoperative residual PS in cToF patients remain unclear. Pulmonary valve replacement (PVR) is frequently needed during follow-up of cToF patients. The aim of the current study was to determine the role of residual PS in the need for PVR during follow-up in cToF patients.


cToF patients were included if clinical follow-up after primary surgical correction had taken place for a minimum of 5 years. Patient characteristics, surgical factors, and postoperative factors were reviewed, with a special focus on the transpulmonic systolic gradient. Cox proportional hazards regression analysis was performed to identify predictors of PVR.


Of 171 cToF patients, 71 (41.5%) underwent PVR after 24.2 years (interquartile range, 16.8–31.6 years). Year of birth, older age at corrective operation, and patch use significantly predicted PVR during follow-up. By contrast, a mild residual PS in cToF patients (peak systolic gradient, 15–30 mm Hg) independently reduced the risk of PVR, as compared with patients without PS (hazard ratio, 0.47;p= 0.02) and with moderate-to-severe PS (hazard ratio, 0.35;p= 0.01).


In addition to the known risks factors for PVR, a postoperative mild residual PS reduces the risk of PVR during follow-up of cToF patients. This finding provides clinical evidence for a conservative PS relief during correction of ToF.

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