An Evaluation of Predictive Factors for Pulmonary Valve Replacement after Total Correction in Children with tetralogy of Fallot

Congenital heart defects, with a prevalence of 4-8 cases per 1000 births, are one of the most common congenital defects. Tetralogy of Fallot (ToF) is the most common congenital cyanotic disease. There are several techniques for correcting this anomaly and ToF total correction is a routine option. Approximately 40% of patients undergoing ToF, need Pulmonary Valve Replacement (PVR) in the years after primary surgery. In this study, we investigated the predictive factors of PVR in patients with ToF.
The participants included 204 ToF patients who had undergone ToFTC surgery during 2004-2020. Many factors inducing age, sex, weight, pre-ToFTC echocardiographic findings, pre-ToFTC angiographic findings, pre-ToFTC palliative care, type of ToFTC surgery, and echocardiographic features of PVR were extracted and studied.
The mean age at ToFTC was 27.8 months in the PVR group and 58.8 months in ToFTC + PVR group (P < 0.001). Among echocardiographic findings before ToFTC surgery, RV function (P = 0.003), RPA (P = 0.015) and MPA (P = 0.036) were significantly different between the two groups. Valvotomy + VSD Closure surgery were significantly more prevalent among ToFTC patients (P = 0.001); however, Transannular Patch and Monocusp Implantation were done at higher rates among PVR patients. More palliative care before surgery was reported among PVR patients (P = 0.001), but ASD repair was more prevalent in the other group (P < 0.001) which was probably due to two more prevalence of ASD among patients of ToFTC group.
Need for PVR surgery is affected by several factors, including demographic characteristics of patients and characteristics of surgical interventions, along with the anatomical and functional features of the heart.