Transcatheter vs Surgical PVR in TOF — EECC MCQ

Correct answer: D — Transcatheter PVR (Melody, SAPIEN) is preferred when the anatomy is suitable — requires a conduit or previously implanted bioprosthesis as a landing zone; native RVOT anatomy without a conduit may require surgical PVR as the first intervention, with future transcatheter valve-in-valve as a planned long-term strategy

PVR approach in repaired TOF per the 2020 ESC ACHD Guidelines: (1) Transcatheter PVR (Melody — bovine jugular vein valve in a platinum-iridium stent; SAPIEN — balloon-expandable THV): suitable when there is a previously placed RV-PA conduit or bioprosthetic valve providing a 'landing zone'; success rates >95%; advantages: no sternotomy, shorter recovery, lower procedural risk; (2) Surgical PVR: required when there is no conduit (native RVOT patched without a defined landing zone — the most common scenario after transannular patch repair); options include bioprosthetic valve (most common), homograft, or mechanical valve (rare due to need for anticoagulation); (3) LIFETIME STRATEGY: surgical PVR first (creating a defined landing zone) with planned future transcatheter valve-in-valve replacements — this 'investment' approach reduces the total number of surgical reoperations. Choice is made by the ACHD Heart Team based on anatomy (CT/MRI), prior interventions, and patient factors.

Reference: ESC (2020): ACHD Guidelines