Advancements in optimizing pulmonary valve replacement outcomes in tetralogy of Fallot

Pulmonary valve replacement (PVR) for patients with repaired tetralogy of Fallot (ToF) represents a crucial area within congenital heart disease management. Despite the remarkable improvements in early surgical outcomes and long-term survival following ToF repair, chronic pulmonary regurgitation remains nearly universal, resulting in progressive right ventricular (RV) dilation and dysfunction. This pathophysiologic cascade elevates the risks of arrhythmias, heart failure, and sudden cardiac death. Recent studies have explored a wide range of clinical, imaging, and electrophysiological markers—such as RV size and function, QRS characteristics, and exercise performance—to optimize timing and selection criteria for PVR. However, inconsistencies in identifying reliable thresholds and predicting post-intervention trajectories have led to gaps in consensus, with debate ongoing regarding the impact of PVR on long-term survival, functional capacity, arrhythmic burden, and re-intervention risks.

This Research Topic aims to systematically advance knowledge regarding the optimal timing, patient selection, technique, and durability of PVR in those with repaired ToF. We seek to clarify the predictive value of emerging risk factors, harmonize criteria for intervention, and explore the comprehensive influence of PVR on survival rates, ventricular remodeling, functional status, arrhythmogenic risk, and device implantation. By aggregating both pediatric and adult data, as well as leveraging advanced diagnostic modalities and contemporary outcome measures, this Research Topic intends to foster evidence-based guidelines and enhance personalized clinical care.

Given the complexity and evolving landscape of PVR following ToF repair, this Research Topic covers both the breadth and depth of current and emerging areas of investigation, while focusing exclusively on patients who have undergone initial anatomical correction. To gather further insights in optimizing outcomes after PVR, we welcome articles addressing, but not limited to, the following themes:
• Adverse outcomes post-PVR, including sudden cardiac death, cardiac arrest, heart failure mortality, and ventricular or supraventricular arrhythmias
• Short- and long-term changes in functional capacity as measured by cardiopulmonary exercise testing (e.g., VO2, VE/VCO2 slope, oxygen pulse)
• Longitudinal assessment of RV and biventricular dimensions and function, and their association with prosthetic valve performance
• Comparative analysis of prosthetic valve durability by type and implantation technique, including rates of re-intervention
• Incidence, predictors, and outcomes of ICD and/or pacemaker implantation after PVR
• Application of advanced imaging, electrophysiological surveillance, and innovative exercise testing in risk stratification and timing of intervention

We encourage original research articles, longitudinal cohort studies, and systematic reviews. The inclusion of studies utilizing advanced imaging, contemporary electrophysiology, and novel exercise methodologies will further enhance the translational value of this body of work.

Article types and fees

This Research Topic accepts the following article types, unless otherwise specified in the Research Topic description:

• Brief Research Report
• Case Report
• Clinical Trial
• Editorial
• FAIR² Data
• FAIR² DATA Direct Submission
• General Commentary
• Hypothesis and Theory
• Methods
• ... View all formats

Articles that are accepted for publication by our external editors following rigorous peer review incur a publishing fee charged to Authors, institutions, or funders.

Article types

This Research Topic accepts the following article types, unless otherwise specified in the Research Topic description:

• Brief Research Report
• Case Report
• Clinical Trial
• Editorial
• FAIR² Data
• FAIR² DATA Direct Submission
• General Commentary
• Hypothesis and Theory
• Methods
• Mini Review
• Opinion
• Original Research
• Perspective
• Policy and Practice Reviews
• Review
• Study Protocol
• Systematic Review
• Technology and Code

Keywords: Tetralogy of Fallot (ToF), Pulmonary valve replacement (PVR), Pulmonary regurgitation, Right ventricular (RV) dilation, Arrhythmias, Risk stratification, Prosthetic valve durability, Exercise capacity

Important note: All contributions to this Research Topic must be within the scope of the section and journal to which they are submitted, as defined in their mission statements. Frontiers reserves the right to guide an out-of-scope manuscript to a more suitable section or journal at any stage of peer review.