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CC BY 4.0 · Thorac Cardiovasc Surg 2026; 74(S 03): e9-e16
DOI: 10.1055/a-2796-6906
Pediatric and Congenital Cardiology

A Comparison of Treatment Options for Right Ventricular Outflow Tract Obstruction

Authors

  • Sarah Simona Rahlfs    ‡

    1   Klinik und Poliklinik für Kinderherzmedizin und Erwachsene mit angeborenen Herzfehlern, Universitätsklinikum Hamburg-Eppendorf, Hamburg, HH, Germany

  • Jörg Siegmar Sachweh   ‡

    2   Abteilung für Interdisziplinäres Kinderherzprogramm, Universitätsklinikum Hamburg-Eppendorf Universitäres Herzzentrum Hamburg GmbH, Hamburg, German

  • Rainer Gerhard Kozlik-Feldmann

    2   Abteilung für Interdisziplinäres Kinderherzprogramm, Universitätsklinikum Hamburg-Eppendorf Universitäres Herzzentrum Hamburg GmbH, Hamburg, German

  • Daniel Biermann 

    3   Department of Surgery for Congenital Heart Disease, University Heart and Vascular Center Hamburg, Hamburg, Germany

  • Michael Hübler

    4   Universitätsklinikum Hamburg-Eppendorf, Hamburg, HH, Germany

  • Henning Carstens

    2   Abteilung für Interdisziplinäres Kinderherzprogramm, Universitätsklinikum Hamburg-Eppendorf Universitäres Herzzentrum Hamburg GmbH, Hamburg, German
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Abstract

Background

Right ventricular outflow tract (RVOT) obstruction is a hallmark of tetralogy of Fallot (ToF) and related anatomies. Surgical strategies include valve-sparing techniques or transannular patch (TAP) enlargements, optionally with monocusp patch plasty to restore valve competence. This study compares short- and medium-term outcomes of these strategies based on institutional data.

Methods

A retrospective analysis was conducted on 83 ToF patients who underwent surgery between 2007 and 2021. Median age and weight at surgery were 164 days and 6.0 kg, respectively. Patients were grouped by surgical approach: valve-sparing (commissurotomy/delamination, n = 27; primary infundibulotomy, n = 7) and TAP (without monocusp, n = 38; with monocusp, n = 11). The primary endpoint was freedom from reintervention.

Results

Significant preoperative differences were found between groups, including valve morphology, pulmonary annulus z-values, oxygen saturation, and prior palliative interventions. Valve-sparing techniques were associated with less postoperative moderate/severe pulmonary regurgitation (17.6% versus 73.5%; p < 0.001) and a trend toward shorter ICU stays. TAP with monocusp resulted in significantly less pulmonary regurgitation than TAP alone (36.4% versus 84.2%; p = 0.002) and showed a trend toward fewer reinterventions after 5 years (0% versus 38.5%; p = 0.073), with a significant difference at 10 years (14.3% versus 71.4%; p = 0.024).

Conclusion

Valve-sparing approaches yield better early outcomes and fewer long-term reinterventions when anatomically feasible. When TAP is necessary, adding a monocusp patch significantly reduces postoperative regurgitation and improves long-term durability.

Keywords

pediatric - pulmonary valve - congenital heart disease - CHD - ToF - Fallot - Monocusp

‡ These authors share first authorship.




Publication History

Received: 22 July 2025

Accepted: 23 January 2026

Article published online:
27 February 2026

© 2026. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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