{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T01:58:46Z","timestamp":1773971926282,"version":"3.50.1"},"reference-count":21,"publisher":"Georg Thieme Verlag KG","issue":"S 03","license":[{"start":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T00:00:00Z","timestamp":1772150400000},"content-version":"vor","delay-in-days":57,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Thorac Cardiovasc Surg"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n                  <jats:p>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\u2009kg, respectively. Patients were grouped by surgical approach: valve-sparing (commissurotomy\/delamination, n\u2009=\u200927; primary infundibulotomy, n\u2009=\u20097) and TAP (without monocusp, n\u2009=\u200938; with monocusp, n\u2009=\u200911). The primary endpoint was freedom from reintervention.<\/jats:p>\n                  <jats:p>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\u2009&lt;\u20090.001) 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\u2009=\u20090.002) and showed a trend toward fewer reinterventions after 5 years (0% versus 38.5%; p\u2009=\u20090.073), with a significant difference at 10 years (14.3% versus 71.4%; p\u2009=\u20090.024).<\/jats:p>\n                  <jats:p>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.<\/jats:p>","DOI":"10.1055\/a-2796-6906","type":"journal-article","created":{"date-parts":[[2026,2,28]],"date-time":"2026-02-28T02:19:48Z","timestamp":1772245188000},"page":"e9-e16","source":"Crossref","is-referenced-by-count":0,"special_numbering":"S","title":["A Comparison of Treatment Options for Right Ventricular Outflow Tract Obstruction"],"prefix":"10.1055","volume":"74","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-3314-9690","authenticated-orcid":false,"given":"Sarah Simona","family":"Rahlfs","sequence":"additional","affiliation":[{"name":"Klinik und Poliklinik f\u00fcr Kinderherzmedizin und Erwachsene mit angeborenen Herzfehlern, Universit\u00e4tsklinikum Hamburg-Eppendorf, Hamburg, HH, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J\u00f6rg Siegmar","family":"Sachweh","sequence":"additional","affiliation":[{"name":"Abteilung f\u00fcr Interdisziplin\u00e4res Kinderherzprogramm, Universit\u00e4tsklinikum Hamburg-Eppendorf Universit\u00e4res Herzzentrum Hamburg GmbH, Hamburg, German"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rainer Gerhard","family":"Kozlik-Feldmann","sequence":"additional","affiliation":[{"name":"Abteilung f\u00fcr Interdisziplin\u00e4res Kinderherzprogramm, Universit\u00e4tsklinikum Hamburg-Eppendorf Universit\u00e4res Herzzentrum Hamburg GmbH, Hamburg, German"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1895-8570","authenticated-orcid":false,"given":"Daniel","family":"Biermann","sequence":"additional","affiliation":[{"name":"Department of Surgery for Congenital Heart Disease, University Heart and Vascular Center Hamburg, Hamburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"H\u00fcbler","sequence":"additional","affiliation":[{"name":"Universit\u00e4tsklinikum Hamburg-Eppendorf, Hamburg, HH, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Henning","family":"Carstens","sequence":"additional","affiliation":[{"name":"Abteilung f\u00fcr Interdisziplin\u00e4res Kinderherzprogramm, Universit\u00e4tsklinikum Hamburg-Eppendorf Universit\u00e4res Herzzentrum Hamburg GmbH, Hamburg, German"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2026,2,27]]},"reference":[{"key":"ref1","first-page":"969","volume-title":"Heart Disease: In Infants, Children and Adolescents","author":"H D Allen","year":"2013"},{"issue":"08","key":"ref2","doi-asserted-by":"crossref","first-page":"2836","DOI":"10.1111\/jocs.15584","article-title":"Architecture matters: tissue preservation strategies for tetralogy of Fallot repair","volume":"36","author":"T Shimoda","year":"2021","journal-title":"J Card Surg"},{"key":"ref3","first-page":"S101","article-title":"[Fallot'sche Tetralogie]","volume":"72","author":"H Bertram","year":"2024","journal-title":"Thorac Cardiovasc Surg"},{"issue":"06","key":"ref4","doi-asserted-by":"crossref","first-page":"1757","DOI":"10.1016\/j.jtcvs.2016.02.015","article-title":"Pulmonary valve-sparing techniques during repair of tetralogy of Fallot: the delamination plasty","volume":"151","author":"V L Vida","year":"2016","journal-title":"J Thorac Cardiovasc Surg"},{"issue":"05","key":"ref5","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1093\/eurheartj\/ehi091","article-title":"Pulmonary regurgitation: not a benign lesion","volume":"26","author":"B Bouzas","year":"2005","journal-title":"Eur Heart J"},{"issue":"05","key":"ref6","doi-asserted-by":"crossref","first-page":"1336","DOI":"10.1016\/j.jtcvs.2006.12.045","article-title":"Right ventricular outflow tract reconstruction with a polytetrafluoroethylene monocusp valve: a twelve-year experience","volume":"133","author":"J W Brown","year":"2007","journal-title":"J Thorac Cardiovasc Surg"},{"issue":"04","key":"ref7","doi-asserted-by":"crossref","first-page":"1431","DOI":"10.1016\/j.athoracsur.2005.04.016","article-title":"Tetralogy of Fallot: results of a pulmonary valve-sparing strategy","volume":"80","author":"R D Stewart","year":"2005","journal-title":"Ann Thorac Surg"},{"issue":"06","key":"ref8","doi-asserted-by":"crossref","first-page":"2202","DOI":"10.1016\/S0003-4975(02)03844-4","article-title":"Polytetrafluoroethylene monocusp valve technique for right ventricular outflow tract reconstruction","volume":"74","author":"M W Turrentine","year":"2002","journal-title":"Ann Thorac Surg"},{"issue":"02","key":"ref9","doi-asserted-by":"crossref","first-page":"726","DOI":"10.1016\/j.jtcvs.2017.09.019","article-title":"Right ventricular outflow tract reintervention after primary tetralogy of Fallot repair in neonates and young infants","volume":"155","author":"S Balasubramanya","year":"2018","journal-title":"J Thorac Cardiovasc Surg"},{"key":"ref10","first-page":"556","article-title":"Corrective surgery for tetralogy of Fallot. Long term follow-up by postoperative recatheterization in 69 cases and certain surgical considerations","volume":"48","author":"C W Lillehei","year":"1964","journal-title":"J Thorac Cardiovasc Surg"},{"issue":"02","key":"ref11","doi-asserted-by":"crossref","first-page":"463","DOI":"10.1053\/j.semtcvs.2016.05.003","article-title":"Right ventricular outflow tract reconstruction with a polytetrafluoroethylene monocusp valve: a 20-year experience","volume":"28","author":"M Kumar","year":"2016","journal-title":"Semin Thorac Cardiovasc Surg"},{"issue":"01","key":"ref12","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1186\/s12893-022-01474-6","article-title":"Transannular patch repair of tetralogy of Fallot with or without monocusp valve reconstruction: a meta-analysis","volume":"22","author":"X Wei","year":"2022","journal-title":"BMC Surg"},{"key":"ref13","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1186\/1750-1172-4-2","article-title":"Tetralogy of Fallot","volume":"4","author":"F Bailliard","year":"2009","journal-title":"Orphanet J Rare Dis"},{"issue":"07","key":"ref14","doi-asserted-by":"crossref","first-page":"e2118141","DOI":"10.1001\/jamanetworkopen.2021.18141","article-title":"Comparison of long-term outcomes of valve-sparing and transannular patch procedures for correction of tetralogy of Fallot","volume":"4","author":"S Blais","year":"2021","journal-title":"JAMA Netw Open"},{"issue":"10","key":"ref15","doi-asserted-by":"crossref","first-page":"2156","DOI":"10.1017\/S1047951124025575","article-title":"Primary versus staged repair for tetralogy of Fallot in symptomatic neonates: systematic review and meta-analysis","volume":"34","author":"P W Busro","year":"2024","journal-title":"Cardiol Young"},{"issue":"03","key":"ref16","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1177\/2150135118757991","article-title":"Optimal use of Z-scores to preserve the pulmonary valve annulus during repair of tetralogy of Fallot","volume":"9","author":"M N Awori","year":"2018","journal-title":"World J Pediatr Congenit Heart Surg"},{"issue":"05","key":"ref17","doi-asserted-by":"crossref","first-page":"189","DOI":"10.3345\/kjp.2019.01060","article-title":"Importance of pulmonary valve morphology for pulmonary valve preservation in tetralogy of Fallot surgery: comparison of the echocardiographic parameters","volume":"63","author":"S J Choi","year":"2020","journal-title":"Clin Exp Pediatr"},{"issue":"01","key":"ref18","doi-asserted-by":"crossref","first-page":"39","DOI":"10.21470\/1678-9741-2020-0059","article-title":"Short-term outcome of polytetrafluoroethylene membrane valve versus transannular pericardial patch reconstruction of right ventricular outflow tract in tetralogy of Fallot: a randomized controlled trial","volume":"36","author":"S Rawat","year":"2021","journal-title":"Braz J Cardiovasc Surg"},{"issue":"01","key":"ref19","doi-asserted-by":"crossref","first-page":"5","DOI":"10.4103\/0974-2069.126538","article-title":"Early and 1-year outcome and predictors of adverse outcome following monocusp pulmonary valve reconstruction for patients with tetralogy of Fallot: a prospective observational study","volume":"7","author":"D Sasikumar","year":"2014","journal-title":"Ann Pediatr Cardiol"},{"issue":"05","key":"ref20","doi-asserted-by":"crossref","first-page":"344","DOI":"10.5090\/kjtcs.2016.49.5.344","article-title":"Surgical results of monocusp implantation with transannular patch angioplasty in tetralogy of Fallot repair","volume":"49","author":"W S Jang","year":"2016","journal-title":"Korean J Thorac Cardiovasc Surg"},{"issue":"03","key":"ref21","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1016\/j.ejcts.2010.02.030","article-title":"The long-term result of total repair for tetralogy of Fallot","volume":"38","author":"C S Park","year":"2010","journal-title":"Eur J Cardiothorac Surg"}],"container-title":["The Thoracic and Cardiovascular Surgeon"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2796-6906.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T00:52:50Z","timestamp":1773967970000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2796-6906"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":21,"journal-issue":{"issue":"S 03","published-online":{"date-parts":[[2026,2,2]]},"published-print":{"date-parts":[[2026,1]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2796-6906","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0171-6425","1439-1902"],"issn-type":[{"value":"0171-6425","type":"print"},{"value":"1439-1902","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]}}}