Whether Pulmonary Valve Replacement in Asymptomatic Patients With Moderate or Severe Regurgitation After Tetralogy of Fallot Repair Is Appropriate: A Case-Control Study

Background-Although right ventricular (RV) volume was significantly decreased in symptomatic patients with repaired tetralogy of Fallot (rTOF) after pulmonary valve replacement (PVR), RV size was still enlarged along with RV dysfunction. Methods and Results-A prospective case-control study was conducted in a tertiary hospital; 81 asymptomatic repaired tetralogy of Fallot patients with moderate or severe pulmonary regurgitation were enrolled. The enrolled cohort was divided into 2 groups: PVR group (n=41) and medication group (n=40). Cardiac magnetic resonance, transthoracic echocardiography, and electrocardiography were scheduled after recruitment and 6 months after PVR or recruitment. Adverse events were recorded during follow-up. Three deaths, 1 heart transplantation, 3 PVRs, and 2 symptomatic heart failures in medication group and 1 redo PVR in the PVR group were observed during follow-up. Compared with the medication group, the PVR group had significantly lower adverse events rate (P 0.023; odds ratio, 0.086; 95% CI, 0.010-0.716), and RV function was significantly improved (P<0.05). Binary logistic regression analysis identified preoperative RV end-systolic volume index (10-mL/m(2) increment, P=0.009; odds ratio, 0.64; 95% CI, 0.457-0.893) was an independent predictor of normalization of RV size after PVR. A preoperative RV end-systolic volume index cut-off value of 120 mL/m(2) (area under curve, 0.819; sensitivity, 90.3%; specificity, 70%) was analyzed by receiver operating characteristic curves for normalized RV size after PVR. Conclusions-PVR in asymptomatic repaired tetralogy of Fallot patients is appropriate and effective in reducing right ventricular size and preserving right ventricular function. The recommended criterion of RV end-systolic volume index for PVR is 120 mL/m(2).