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. 2025 May 28;20(1):243.
doi: 10.1186/s13019-025-03475-x.

Predictors of successful pulmonary valve-sparing repair in pediatric humanitarian patients with Tetralogy of Fallot

Vitor Mendes  1   2 , Abdelkhalek Mouloudi  3 , Jalal Jolou  3 , Tomasz Nalecz  3 , Ana Abecasis  4 , Telmo Pereira  5 , Tornike Sologashvili  3
Affiliations

Predictors of successful pulmonary valve-sparing repair in pediatric humanitarian patients with Tetralogy of Fallot

Vitor Mendes et al. J Cardiothorac Surg. .

Abstract

Introduction: The optimal surgical approach for right ventricular outflow tract obstruction in Tetralogy of Fallot aims to preserve the native pulmonary valve annulus, as this is associated with better long-term outcomes. Pediatric humanitarian patients often present with a delayed diagnosis and lack access to preoperative palliative treatments, reducing the likelihood of pulmonary valve annulus preservation and potentially compromising long-term outcomes. This study aims to identify independent predictors of successful pulmonary valve-sparing repair in pediatric humanitarian patients undergoing corrective surgery for Tetralogy of Fallot.

Methods: Between January 2019 and May 2023, pediatric humanitarian patients with Tetralogy of Fallot underwent surgical correction at our center. We performed a comparative analysis of preoperative, intraoperative, and postoperative variables, followed by univariate and multivariate logistic regression to identify independent predictors of pulmonary valve-sparing repair.

Results: A lower body mass index (OR = 0.711; p = 0.021; 95% CI = 0.533-0.949), a larger pulmonary valve annulus measured in centimeters (OR = 28.653; p = 0.008; 95% CI = 2.360-347.890) and a higher Z-score of pulmonary valve annulus (OR = 1.606; p = 0.023; 95% CI = 1.067-2.418) were identified as independent predictors of pulmonary valve-sparing repair.

Conclusion: Successful pulmonary valve-sparing repair was associated with lower BMI and a larger pulmonary valve annulus (both measurements in centimeters and Z-score). These findings may help guide clinical and policy strategies to promote more equitable and effective surgical care in resource-limited settings.

Keywords: Pediatric humanitarian patients; Pulmonary valve-sparing repair; Tetralogy of Fallot.

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Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
The ROC Curves for the three continuous predictors of successful pulmonary valve-sparing repair. A- ROC Curve for BMI; B- ROC Curve for pulmonary valve annulus diameter in centimeters; C- ROC Curve for pulmonary valve annulus Z-Score
See this image and copyright information in PMC

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