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Interact CardioVasc Thorac Surg 2009;9:520-527. doi:10.1510/icvts.2009.211011
© 2009 European Association of Cardio-Thoracic Surgery
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Hunaid A. Vohra
Marcus P. Haw
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Best evidence topic - Congenital

Does pulmonary valve replacement post repair of tetralogy of Fallot improve right ventricular function?

Louise Adamson, Hunaid A. Vohra and Marcus P. Haw*

Department of Cardiothoracic Surgery, Southampton General Hospital, Southampton, UK

*Corresponding author. Department of Paediatric Cardiac Surgery, Wessex Cardiothoracic Centre, Southampton University Hospitals NHS Trust, Southampton General Hospital, Tremona Road, Southampton, UK. Tel.: +44 2380 777222; fax: +44 2380 794526.

E-mail address: Marcus.Haw{at}suht.swest.nhs.uk (M.P. Haw).

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether pulmonary valve replacement (PVR) after repair of tetralogy of Fallot improved outcomes including right ventricular (RV) function. Altogether 730 relevant papers were identified using the below mentioned search, 19 papers represented the best evidence to answer the question. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses were tabulated. We conclude that PVR after tetralogy of Fallot repair has been shown to improve RV function and to offer symptomatic benefit. Several retrospective reviews report consistent reductions in RV end diastolic and systolic volumes and improvement in RV stroke volume, with one study also finding improvement in left ventricular stroke volume. PVR in this population appears to result in improved clinical outcome and can be performed with low mortality.

Key Words: Pulmonary valve replacement; Tetralogy of Fallot; Cardiac surgery; Right ventricular function; Evidence based medicine; Review

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