Comparison of Transannular Patch and Valve-Sparing Repair Techniques in Tetralogy of Fallot: A Clinical Review

Medicine/Surgery

Tetralogy of Fallot (TOF) – the most common cyanotic congenital heart defect (CHD) in children – requires surgical repair to correct right ventricular outflow tract (RVOT) obstruction, ventricular septal defect (VSD), and maintain pulmonary valve (PV) function. This clinical review synthesizes 39 high-quality studies (2014–2025) encompassing 7,842 pediatric TOF patients to directly compare two primary repair techniques: transannular patch (TAP) repair and valve-sparing (VS) repair. Key endpoints evaluated included early outcomes (operative time, cardiopulmonary bypass [CPB] duration, hospital stay, mortality) and long-term outcomes (pulmonary regurgitation [PR] severity, right ventricular [RV] dilation, reoperation rate, exercise tolerance). VS repair was associated with superior long-term PV function: mild-to-moderate PR occurred in 28% of VS patients vs. 76% of TAP patients at 5 years, with RV dilation (z-score >2) reported in 15% of VS vs. 48% of TAP patients. Early outcomes were comparable: operative time (142 vs. 138 minutes), CPB duration (68 vs. 65 minutes), and 30-day mortality (<0.5% for both). Reoperation rates for PV dysfunction were 8% for VS vs. 29% for TAP at 10 years. Subgroup analysis confirmed VS repair as the preferred approach for patients with a native PV annulus ≥15 mm and minimal RVOT hypoplasia, while TAP remained indicated for severe RVOT hypoplasia (annulus <12 mm) or anomalous coronary anatomy. This review concludes that VS repair is a safe, durable alternative to TAP for select TOF patients, offering long-term benefits of preserved PV function, reduced RV morbidity, and fewer reoperations – critical for pediatric growth and quality of life. These findings provide frontline cardiothoracic surgeons with evidence-based guidance to optimize TOF repair outcomes.

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