{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,29]],"date-time":"2025-10-29T03:47:09Z","timestamp":1761709629368,"version":"build-2065373602"},"reference-count":16,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2019,5,4]],"date-time":"2019-05-04T00:00:00Z","timestamp":1556928000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>There is a lack of consensus regarding the preoperative pulmonary valve (PV) Z-score \u201ccut-off\u201d in tetralogy of Fallot (ToF) patients to attempt a successful valve sparing surgery (VSS). Therefore, the aim of this study was to review the available evidence regarding the association between preoperative PV Z-score and rate of re-intervention for residual right ventricular outflow tract (RVOT) obstruction, i.e. successful valve sparing surgery. A systematic search of studies reporting outcomes of VSS for ToF was performed utilizing PubMed, EMBASE, and Scopus databases. Patients with ToF variants such as pulmonary atresia, major aortopulmonary collaterals, absent pulmonary valve, associated atrioventricular septal defect, and discontinuous pulmonary arteries were excluded. Out of 712 screened publications, 15 studies met inclusion criteria. A total of 1091 patients had surgery at a median age and weight of 6.9 months and 7.2 kg, respectively. VSS was performed on the basis of intraoperative PV assessment in 14 out of 15 studies. The median preoperative PV Z-score was \u22121.7 (0 to \u22124.9) with a median re-intervention rate of 4.7% (0\u201336.8%) during a median follow-up of 2.83 years (1.4\u201315.8 years). Quantitatively, there was no correlation between decreasing preoperative PV Z-scores and increasing RVOT re-intervention rates with a correlation coefficient of \u22120.03 and an associated p-value of 0.91. In observational studies, VSS for ToF repair was based on intraoperative evaluation and sizing of the PV following complete relief of all levels of obstruction of the RVOT, rather than pre-operative echocardiography derived PV Z-scores.<\/jats:p>","DOI":"10.3390\/children6050067","type":"journal-article","created":{"date-parts":[[2019,5,13]],"date-time":"2019-05-13T05:35:39Z","timestamp":1557725739000},"page":"67","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Validity of Pulmonary Valve Z-Scores in Predicting Valve-Sparing Tetralogy Repairs\u2014Systematic Review \u2020"],"prefix":"10.3390","volume":"6","author":[{"given":"Raina","family":"Sinha","sequence":"first","affiliation":[{"name":"Division of Pediatric and Congenital Cardiac Surgery, UT-Houston McGovern Medical School, Children\u2019s Memorial Hermann Hospital, 6431 Fannin Street, MSB 6.264, Houston, TX 77030, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1826-3568","authenticated-orcid":false,"given":"Vasu","family":"Gooty","sequence":"additional","affiliation":[{"name":"Division of Pediatric Cardiology, University of Texas Southwestern, Dallas Children\u2019s Medical Center, 1935 Medical District Drive, Dallas, TX 75235, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2950-8487","authenticated-orcid":false,"given":"Subin","family":"Jang","sequence":"additional","affiliation":[{"name":"Division of Pediatric Cardiac Surgery, University of Minnesota, Masonic Children\u2019s Hospital, 2450 Riverside Ave, Minneapolis, MN 55454, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ali","family":"Dodge-Khatami","sequence":"additional","affiliation":[{"name":"Division of Pediatric and Congenital Cardiac Surgery, UT-Houston McGovern Medical School, Children\u2019s Memorial Hermann Hospital, 6431 Fannin Street, MSB 6.264, Houston, TX 77030, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jorge","family":"Salazar","sequence":"additional","affiliation":[{"name":"Division of Pediatric and Congenital Cardiac Surgery, UT-Houston McGovern Medical School, Children\u2019s Memorial Hermann Hospital, 6431 Fannin Street, MSB 6.264, Houston, TX 77030, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2019,5,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13019-018-0702-0","article-title":"Surgical strategies protecting against right ventricular dilatation following tetralogy of Fallot repair","volume":"13","author":"Arafat","year":"2018","journal-title":"J. Cardiothorac. Surg."},{"key":"ref_2","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":"Awori","year":"2018","journal-title":"World J. Pediatr. Congenit. Heart Surg."},{"key":"ref_3","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":"Stewart","year":"2005","journal-title":"Ann. Thorac. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"885","DOI":"10.1016\/j.ejcts.2009.01.016","article-title":"Current strategies in tetralogy of Fallot repair: Pulmonary valve sparing and evolution of right ventricle\/left ventricle pressures ratio","volume":"35","author":"Boni","year":"2009","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_5","first-page":"1221","article-title":"A new pulmonary valve cusp plasty technique markedly decreases transannular patch rate and improves midterm outcomes of tetralogy of Fallot","volume":"40","author":"Hua","year":"2011","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_6","first-page":"126","article-title":"Assessment of a right-ventricular infundibulum-sparing approach in transatrial-transpulmonary repair of tetralogy of Fallot","volume":"41","author":"Panzer","year":"2012","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"915","DOI":"10.1002\/ccd.24349","article-title":"The balloon dilation of the pulmonary valve during early repair of tetralogy of Fallot","volume":"80","author":"Vida","year":"2012","journal-title":"Catheter Cardiovasc. Interv."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"483","DOI":"10.1093\/ejcts\/ezs372","article-title":"Tetralogy of Fallot repair: Optimal z-score use for transannular patch insertion","volume":"43","author":"Awori","year":"2013","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"918","DOI":"10.1007\/s00246-012-0574-3","article-title":"Valve-sparing tetralogy of Fallot repair with intraoperative dilation of the pulmonary valve","volume":"34","author":"Cardenas","year":"2013","journal-title":"Pediatr. Cardiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"743","DOI":"10.1093\/ejcts\/ezs479","article-title":"Right ventricular outflow tract strategies for repair of tetralogy of Fallot: effect of monocusp valve reconstruction","volume":"43","author":"Sasson","year":"2013","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"802","DOI":"10.1093\/icvts\/ivt095","article-title":"Technical modification enabling pulmonary valve-sparing repair of a severely hypoplastic pulmonary annulus in patients with tetralogy of Fallot","volume":"16","author":"Ito","year":"2013","journal-title":"Interact. Cardiovasc. Thorac. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"802","DOI":"10.1016\/j.jtcvs.2014.06.008","article-title":"Long-term outcomes after definitive repair for tetralogy of Fallot with preservation of the pulmonary valve annulus","volume":"148","author":"Hoashi","year":"2014","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1016\/j.athoracsur.2016.05.056","article-title":"Use of a dacron annular sparing versus limited transannular patch with nominal pulmonary annular expansion in infants with tetralogy of Fallot","volume":"103","author":"Simon","year":"2017","journal-title":"Ann. Thorac. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"822","DOI":"10.1016\/j.athoracsur.2017.11.032","article-title":"Annulus-sparing tetralogy of Fallot repair: Low risk and benefits to right ventricular geometry","volume":"106","author":"Hickey","year":"2018","journal-title":"Ann. Thorac. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1163","DOI":"10.1016\/j.jtcvs.2017.08.147","article-title":"Valve-sparing repair with intraoperative balloon dilation in tetralogy of Fallot: Midterm results and therapeutic implications","volume":"155","author":"Hofferberth","year":"2018","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_16","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":"Balasubramanya","year":"2018","journal-title":"J. Thorac. Cardiovasc. Surg."}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/6\/5\/67\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T12:49:06Z","timestamp":1760186946000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/6\/5\/67"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,5,4]]},"references-count":16,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2019,5]]}},"alternative-id":["children6050067"],"URL":"https:\/\/doi.org\/10.3390\/children6050067","relation":{},"ISSN":["2227-9067"],"issn-type":[{"type":"electronic","value":"2227-9067"}],"subject":[],"published":{"date-parts":[[2019,5,4]]}}}