Repaired tetralogy of Fallot (ToF) requires lifelong follow-up, because right ventricular outflow tract dysfunction — chiefly pulmonary regurgitation and consequent RV dilation and dysfunction — is essentially universal after surgical repair. The 2024 AHA scientific statement emphasizes regular surveillance with echocardiography and cardiac MRI to time reintervention.
The key therapeutic advance is transcatheter pulmonary valve replacement (TPVR). Historically limited to patients with a surgical conduit or bioprosthetic valve (using the Melody and SAPIEN valves), TPVR has been extended to the large, dilated native or patched outflow tract typical after transannular-patch repair — the anatomy of most repaired ToF patients — by self-expanding devices approved in 2021 (the Harmony transcatheter pulmonary valve and the Alterra Adaptive Prestent, which serves as a landing zone for a SAPIEN valve). This has broadened eligibility for a valve-in-native-RVOT approach, reducing pulmonary regurgitation and delaying or avoiding repeat surgery, with real-world outcomes generally excellent; stent fracture and endocarditis remain long-term considerations.
Further reading: AHA scientific statement on RVOT dysfunction in repaired ToF (Geva et al., Circulation 2024); transcatheter interventions for ToF across age groups (Flores-Umanzor et al., JACC Cardiovascular Interventions 2024); Harmony and Alterra self-expanding TPVR registries.