Valve-preserving technique for tetralogy of fallot by transannular delamination

BackgroundValve-sparing repair for tetralogy of Fallot is challenging in patients with hypoplastic pulmonary valves. Recently, we adopted transannular incision and delamination. This study evaluates its feasibility for right ventricular outflow relief, valve function, and growth.MethodsWe retrospectively reviewed records of patients with tetralogy of Fallot or Fallot-type double-outlet right ventricle who underwent intracardiac repair from October 2013 to December 2020.ResultsTwenty-six patients were enrolled. Two patients who underwent the Rastelli procedure were excluded, leaving 24 for evaluation. Eleven underwent valve-sparing repair, eight underwent valve-preserving repair with transannular delamination, and five underwent the transannular patch procedure. The median age and weight at surgery were 11.7 months (1.9-40.2 months) and 7.6 kg (3.7-12.7 kg). No patients died or required reintervention for pulmonary valve stenosis or regurgitation during a median follow-up of 42.5 months (4.6-72.1 months). In the delamination group, the mean preoperative pulmonary valve z-score was -2.1 ± 1.0, improving significantly to 0.2 ± 0.8. Pulmonary regurgitation was mild in six of eight patients, while two with the smallest preoperative annulus developed moderate regurgitation. Despite no significant difference in the preoperative pulmonary valve annulus between the delamination and transannular patch groups, the delamination group had significantly lower postoperative pulmonary valve regurgitation, while no significant difference in stenosis.ConclusionsValve-preserving repair using the transannular delamination technique is feasible in patients with tetralogy of Fallot, reducing pulmonary regurgitation and avoiding transannular patch use. Long-term data with more patients are required to show the utility of this approach.