Early and Midterm Reintervention in Valve-Sparing Tetralogy of Fallot Repair: Role of Residual Lesion Score

Tetralogy of Fallot (TOF) is a common congenital heart defect with a traditionally high reintervention rate of post-surgical correction. The Residual Lesion Score (RLS) is a tool used to evaluate the quality of surgical outcomes by assessing postoperative echocardiography findings and the need for unplanned reinterventions. The study assesses the association between the Residual Lesion Score (RLS) and early and midterm outcomes, including reintervention rates, in patients undergoing valve-sparing TOF repair at a tertiary care center in a low- and middle-income country (LMIC). We conducted a retrospective analysis of 62 patients who underwent valve-sparing TOF repair between January 2017 and December 2019 at Aga Khan University, Pakistan. The RLS was calculated based on postoperative echocardiograms and unplanned surgical or catheter-based reinterventions. Patients were categorized into RLS 1 (trivial or no residual lesions), RLS 2 (minor residual lesions), and RLS 3 (major residual lesions or reinterventions before discharge). Two (3.2%) patients lacked postoperative echocardiography, were assigned an RLS score of 5, and excluded from further analysis. Of the 60 patients, 13 (21%) had an RLS of 3, indicating major residual lesions, and 29 (48.3%) had an RLS of 2, indicating minor residual lesions. Early reinterventions were required in 11.7% of patients. Patients with RLS 3 had a significantly higher reintervention rate compared to those with RLS 2 (p = 0.003) reintervention and longer hospital stay (p-value = 0.3). Implementing RLS can help optimize postoperative management and patient outcomes by identifying patients at higher risk of early reintervention.