Monocusp pulmonary valve reconstruction in childhood and adult TOF repairs: does a single cusped valve work?

Objectives This study aimed to study and compare short-term surgical outcomes over a period of 3 years in three groups of childhood and adult patients undergoing intracardiac repair for Tetralogy of Fallot: patients undergoing transannular patching without pulmonary valve reconstruction, transannular patching with pulmonary valve reconstruction using pericardial monocusp valves and patients undergoing transannular patching with pulmonary valve reconstruction using polytetrafluoroethylene (PTFE) monocusp valves. Methods A total of 90 patients were included in the study. In group A (30 patients), transannular patch was placed without pulmonary valve reconstruction. In group B (30 patients), pericardial monocusp patch was created under the transannular patch which was sutured to right ventricular outflow tract (RVOT). In group C (30 patients), 0.1-mm PTFE membrane valve monocusp was created under the transannular patch which was sutured to RVOT. Patients were compared in terms of postoperative course in ICU and echocardiographic findings and NYHA status at 3 years. Results Patient with pulmonary valve reconstruction had significantly less incidence of pulmonary regurgitation and right ventricular dysfunction immediately after surgery and at 3 years postoperatively. Pulmonary valve reconstruction was associated with slightly higher RVOT gradients but the gradients gradually decreased over midterm. Patients with pulmonary valve reconstruction behaved better in intensive care units in terms of ventilation time and ICU stay and had better NYHA status at 3 years. However, patients with pericardial pulmonary valve reconstruction and PTFE membrane reconstruction did not show significant difference in outcome at 3 years.