Comparison of Short-Term Outcomes of Tetralogy of Fallot Repair Between Preserved Pulmonary Valve Annulus and Transannular Patch

BACKGROUND: Tetralogy of Fallot (TOF) repair may involve either preservation of the pulmonary valve annulus (PVA) or use of a transannular patch (TAP) with a polytetrafluoroethylene (PTFE) bicuspid pulmonary valve. This study aimed to compare short-term clinical and echocardiographic outcomes of TOF repair using preserved PVA versus TAP with PTFE valve. METHODS: This prospective, comparative, cross-sectional study was conducted from January 2022 to December 2023 at the National Heart Foundation Hospital & Research Institute, Dhaka. A total of 46 TOF patients were enrolled: 23 underwent PVA-preserving repair (Group A) and 23 received TAP with PTFE bicuspid valve (Group B). Data on postoperative ventilation time, vasoactive inotrope score (VIS), intensive care unit (ICU) stay, morbidity, and echocardiographic parameters were collected up to 12 weeks post discharge. Statistical analysis was performed using Mann-Whitney U and Fisher's exact tests. RESULTS: Group A demonstrated significantly shorter ventilation time (median 5.0 vs. 19.0 hours, p = 0.001), lower VIS (median 9.0 vs. 13.5, p = 0.002), and reduced ICU stay (median 6.0 vs. 7.0 days, p = 0.023). The tricuspid regurgitation peak pressure gradient was significantly lower in Group A at all follow-up points (p < 0.05). No significant differences were observed in overall morbidity, mortality, or incidence of pulmonary regurgitation and right ventricular dysfunction between groups, and no patient required immediate redo surgery for residual right ventricular outflow tract obstruction. CONCLUSION: PVA-preserving TOF repair is associated with better early recovery metrics. However, TAP with a PTFE bicuspid valve remains a safe and effective alternative when valve preservation is not feasible.