Pulmonary Valve Preservation without Right Ventriculotomy in Biventricular Repair of Atrioventricular Septal Defect with Tetralogy of Fallot or Double-Outlet Right VentricleOA

Background:We evaluated surgical outcomes of biventricular repair for atrioventricular septal defect(AVSD)with tetralogy of Fallot(TOF)or double-outlet right ventricle(DORV).Methods:This retrospective pilot study included 12 patients who underwent biventricular repair of AVSD with TOF(n=6)or DORV(n=6)between 2004 and 2023.Right ventricular outflow tract(RVOT)reconstruction was performed using transannular patch(TAP,n=4)or pulmonary valve preservation(PVP,n=8).Clinical outcomes,including longitudinal pulmonary valve growth,RVOT obstruction,and pulmonary regurgitation,were reviewed descriptively,with particular focus on the feasibility of PVP.Results:The median age and body weight at the time of surgery were 11.7(8.3-18.8)months and 8.6(7.3-10.5)kg,respectively.The median follow-up duration was 67.9(58.7-174.3)months.The two-patch technique(n=10)was most commonly used for AVSD repair.There were no early mortalities and one late mortality.At discharge,significant(≥36 mmHg)RVOT obstruction was observed in two patients who underwent PVP.During follow-up,one patient required reoperation for significant(moderate or greater)atrioventricular valve regurgitation,and two patients in the PVP group underwent transcatheter intervention for significant RVOT obstruction.At the last follow-up,significant RVOT obstruction was present in two patients.Significant(moderate or greater)pulmonary regurgitation occurred in three patients in the TAP group.In patients who underwent PVP,the pulmonary valve annulus z-score remained within acceptable ranges,and the RVOT pressure gradient predominantly decreased to acceptable levels during follow-up.Conclusions:Mid-term outcomes of PVP in the biventricular repair of AVSD with TOF or DORV are acceptable.In selected patients,the PVP strategy may be considered a reasonable and feasible option for RVOT reconstruction.