Mid-Term Outcomes of Valve-Sparing Repair With Intraoperative Balloon Dilation in Tetralogy of Fallot

BackgroundLate sequelae associated with chronic severe pulmonary regurgitation (PR) following transannular patch (TAP) repair of tetralogy of Fallot (TOF) have driven the use of alternative approaches. This study investigates mid-term pulmonic valve (PV) durability in TOF patients who underwent valve-sparing repair with intraoperative balloon dilation (VS-IBD).MethodsBetween 2010 and 2022, 139 TOF patients underwent VS-IBD (n = 66) or TAP (n = 73) repair at a single institution. Patients who underwent VS repair without IBD were excluded. Baseline differences were balanced by inverse probability of treatment weighting (IPTW). Primary outcome was freedom from reintervention, with median follow-up of 4.6 years.ResultsValve-sparing repair with intraoperative balloon dilation patients were older (117 vs 64 days, P = .001) with higher PV annulus z-scores (-2.26 vs -2.62, P = .001) compared with TAP patients. After IPTW, VS-IBD patients had a higher reintervention rate (12.6% vs 2.2%, P = .028). At five years, 37/66 (56%) of VS-IBD patients remained free from ≥ moderate PR and 56/66 (85%) free from ≥ moderate pulmonic stenosis (PS). At the latest follow-up, VS-IBD patients demonstrated less right ventricular (RV) dilation (severe: 1.0% vs 15.5%, P = .002) and similar RV function (normal: 88.0% vs 91.8%, P = .273) as their TAP counterparts. In multivariable Cox analysis of VS-IBD patients, female sex (hazard ratio, HR [95% confidence interval, CI]: 4.4 [1.5, 13.2], P = .008) and preoperative PV z-score -2.67 to -2.18 (HR [95% CI]: 5.7 [1.6, 19.6], P = .006) were risk factors for developing ≥ moderate PR.ConclusionsDespite a higher early reintervention rate, the trade-off for VS-IBD patients appears to be better-preserved valve competency overall, as well as less adverse RV remodeling.