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

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.