Redo Fallot: Surgery for Pulmonary Valve Implantation

Since tetralogy of Fallot was first successfully repaired in 1954, an encouraging long-term survival has been reported. However, an increasing number of adult survivors will present late after repair for re-intervention, and pulmonary regurgitation has been the most common indication. The timing and indications for pulmonary valve replacement continue to evolve but the trend has now moved towards earlier intervention before irreversible changes in right ventricular function occur. Late survivors are also at an increased risk of developing arrhythmias due to right ventricular scarring related to corrective surgery and sudden death remains the commonest cause of late death. The need to restore pulmonary valve competency to preserve right ventricular function and reduce the arrhythmia burden have therefore become the important indications for late intervention in this disease. In addition to traditional surgical approaches, the role of percutaneous valve intervention is also emerging. It is anticipated that this strategy will improve the long-term mortality and morbidity and will be the focus of this chapter.