Early outcomes of pulmonary valve replacement in children with significant pulmonary regurgitation after tetralogy of Fallot repair: comparison of surgical bioprosthetic valves, stent bioprosthetic valves and ePTFE valved conduits

Q: What are the key findings of this study?

At a median follow-up of 15 months, pulmonary valve replacement with surgical bioprosthetic valves, stent bioprosthetic valves, or ePTFE conduits resulted in 0% mortality and 0% reoperation across all groups, while surgical valves were associated with significantly faster postoperative recovery.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Significant pulmonary regurgitation after tetralogy of Fallot repair (n=45). Intervention: Surgical bioprosthetic valve (SBV) or stent bioprosthetic valve (Stent-BV) vs. ePTFE valved conduit. Primary outcome: Composite of all-cause mortality and reoperation.

Q: What does this research mean for the field?

In pediatric patients undergoing pulmonary valve replacement after tetralogy of Fallot repair, surgical bioprosthetic valves demonstrate faster postoperative recovery and lower early valve dysfunction than ePTFE valved conduits or stent bioprosthetic valves. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Ma Zhencheng; Huifeng Zhang; Ming Ye; Gang Chen

doi:10.1186/s12893-026-04269-1

October 14, 2026BMC SurgeryOpen Access

Early outcomes of pulmonary valve replacement in children with significant pulmonary regurgitation after tetralogy of Fallot repair: comparison of surgical bioprosthetic valves, stent bioprosthetic valves and ePTFE valved conduits

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Key result

PVR achieves 0% mortality across valve types, with surgical valves linked to faster recovery.

n=45

Why the study?

The optimal prosthesis for pulmonary valve replacement in children with significant pulmonary regurgitation after tetralogy of Fallot repair remains debated.

Does the type of pulmonary valve prosthesis (surgical bioprosthetic, stent bioprosthetic, or ePTFE valved conduit) improve early postoperative recovery and reduce valve dysfunction in children undergoing pulmonary valve replacement for significant pulmonary regurgitation after Tetralogy of Fallot repair?

Key Points

To compare early postoperative recovery and valve dysfunction among three pulmonary valve replacement prostheses in children with significant pulmonary regurgitation following repair of tetralogy of Fallot.
Retrospectively analyzed 45 pediatric patients (2017–2025) undergoing pulmonary valve replacement for severe pulmonary regurgitation after tetralogy of Fallot repair.
Compared surgical bioprosthetic valves (SBV, n = 21), stent bioprosthetic valves (Stent-BV, n = 7), and hand-sewn ePTFE valved conduits (n = 17) over a median follow-up of 15 months.
Evaluated valve dysfunction (defined as moderate/severe pulmonary regurgitation or peak transvalvular gradient ≥ 40 mmHg) and recovery metrics adjusted for pulmonary artery diameter and tricuspid regurgitation.
No mortality, reoperations, or catheter-based interventions occurred during the median follow-up of 15 months.
The SBV group had shorter ventilation duration [6 (4–15) h vs 21 (11–88) h, p < 0.01], CCU stay [2 (1–6) d vs 5 (3–25) d, p < 0.01], and postoperative hospital stay (15.42 ± 3.95 d vs 22.20 ± 6.43 d, p = 0.02) compared to the ePTFE group.
Pulmonary valve dysfunction occurred in 5 patients overall (SBV 0, Stent-BV 3, ePTFE 2; p = 0.04), with moderate pulmonary regurgitation at 12 months present in 0% of SBV, 16.7% of Stent-BV, and 5.9% of ePTFE patients.

Study Design

Type

Cohort (n=45)

Blinding

Single-blind

Randomization

None

Multicenter

No

Structured PICO

Does the type of pulmonary valve prosthesis (surgical bioprosthetic, stent bioprosthetic, or ePTFE valved conduit) improve early postoperative recovery and reduce valve dysfunction in children undergoing pulmonary valve replacement for significant pulmonary regurgitation after Tetralogy of Fallot repair?

P

Population

45 pediatric patients (mean age 12.9 years, 24% female) with moderate to severe pulmonary regurgitation after tetralogy of Fallot repair who underwent pulmonary valve replacement, followed for a median of 15 months.

I

Intervention

Pulmonary valve replacement utilizing a surgical bioprosthetic valve (SBV, n=21) or a stent bioprosthetic valve (Stent-BV, n=7)

C

Comparator

Pulmonary valve replacement utilizing a hand-sewn expanded polytetrafluoroethylene (ePTFE) valved conduit (n=17)

O

Outcome

Composite of all-cause mortality and reoperation (defined as any unplanned pulmonary valve-related surgical intervention)composite

Main Result

Absolute Event Rate: 0% vs 0%

Limitations

Retrospective, single-center design introducing selection bias.
Prosthesis selection was based on anatomy and age rather than randomization, leading to baseline differences and potential residual confounding.
Small overall sample size (n=45), particularly in the stent bioprosthetic valve cohort (n=7).
Short median follow-up of 15 months precludes the assessment of long-term outcomes and prosthesis durability.
Echocardiographic measurements lacked an interobserver variability assessment.
Retrospective, single-center design introduces selection bias
Prosthesis selection was based on anatomy and age rather than randomization
Residual confounding cannot be excluded
Adjunctive procedure was not included as a separate covariate in generalized linear models due to collinearity with preoperative TR and limited sample size
Small overall sample size (n=45), particularly the Stent-BV cohort (n=7)

Implication

Surgical bioprosthetic valves were associated with faster recovery and zero events; leaves open durability and dysfunction comparisons in prospective trials.

Abstract

Significant pulmonary regurgitation (PR) is common after tetralogy of Fallot (TOF) repair and often requires pulmonary valve replacement (PVR) in children. The optimal prosthesis remains debated. We retrospectively analyzed 45 pediatric patients who underwent PVR for significant PR after TOF repair (2017–2025). Three prostheses were compared: surgical bioprosthetic valve (SBV, n = 21), stent bioprosthetic valve (Stent-BV, n = 7), and hand-sewn ePTFE valved conduit ( n = 17). Early outcomes included valve dysfunction (moderate/severe PR or peak gradient ≥ 40 mmHg), recovery metrics. No mortality or reoperation occurred during median follow-up of 15 months. The SBV group had shorter ventilation [6 (4–15)h vs 21(11–88)h, p < 0.01], CCU stay [2 (1–6)d vs 5(3–25)d, p < 0.01], and postoperative hospital stay (15.42 ± 3.95 d vs 22.20 ± 6.43 d, p = 0.02) than the ePTFE group;these differences remained statistically significant after adjusting for PAD and preoperative TR severity using generalized linear models. Pulmonary valve dysfunction occurred in 5 patients (SBV 0, Stent-BV 3, ePTFE 2; p = 0.04). At 12 months, moderate PR was seen in 0% of SBV, 16.7% of Stent-BV, and 5.9% of ePTFE patients. All three prostheses were associated with reduced PR early after PVR. SBV was associated with faster postoperative recovery than the ePTFE conduit. The Stent-BV showed acceptable early hemodynamics but was associated with a higher rate of valve dysfunction. Longer follow-up is needed.

Discussion

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Cite This Study

Zhencheng et al. (2026) conducted a cohort in Significant pulmonary regurgitation after tetralogy of Fallot repair (n=45). Surgical bioprosthetic valve (SBV) or stent bioprosthetic valve (Stent-BV) vs. ePTFE valved conduit was evaluated on Composite of all-cause mortality and reoperation. At a median follow-up of 15 months, pulmonary valve replacement with surgical bioprosthetic valves, stent bioprosthetic valves, or ePTFE conduits resulted in 0% mortality and 0% reoperation across all groups, while surgical valves were associated with significantly faster postoperative recovery.

synapsesocial.com/papers/6ad2187bfc66cec880534e26 https://doi.org/10.1186/s12893-026-04269-1

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Early outcomes of pulmonary valve replacement in children with significant pulmonary regurgitation after tetralogy of Fallot repair: comparison of surgical bioprosthetic valves, stent bioprosthetic valves and ePTFE valved conduits

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Early outcomes of pulmonary valve replacement in children with significant pulmonary regurgitation after tetralogy of Fallot repair: comparison of surgical bioprosthetic valves, stent bioprosthetic valves and ePTFE valved conduits

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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