A Comparison of Treatment Options for Right Ventricular Outflow Tract Obstruction

Abstract Right ventricular outflow tract (RVOT) obstruction is a hallmark of tetralogy of Fallot (ToF) and related anatomies. Surgical strategies include valve-sparing techniques or transannular patch (TAP) enlargements, optionally with monocusp patch plasty to restore valve competence. This study compares short- and medium-term outcomes of these strategies based on institutional data. A retrospective analysis was conducted on 83 ToF patients who underwent surgery between 2007 and 2021. Median age and weight at surgery were 164 days and 6.0 kg, respectively. Patients were grouped by surgical approach: valve-sparing (commissurotomy/delamination, n = 27; primary infundibulotomy, n = 7) and TAP (without monocusp, n = 38; with monocusp, n = 11). The primary endpoint was freedom from reintervention. Significant preoperative differences were found between groups, including valve morphology, pulmonary annulus z-values, oxygen saturation, and prior palliative interventions. Valve-sparing techniques were associated with less postoperative moderate/severe pulmonary regurgitation (17.6% versus 73.5%; p < 0.001) and a trend toward shorter ICU stays. TAP with monocusp resulted in significantly less pulmonary regurgitation than TAP alone (36.4% versus 84.2%; p = 0.002) and showed a trend toward fewer reinterventions after 5 years (0% versus 38.5%; p = 0.073), with a significant difference at 10 years (14.3% versus 71.4%; p = 0.024). Valve-sparing approaches yield better early outcomes and fewer long-term reinterventions when anatomically feasible. When TAP is necessary, adding a monocusp patch significantly reduces postoperative regurgitation and improves long-term durability.