Executive Summary for The Society of Thoracic Surgeons (STS) / World Society for Pediatric and Congenital Heart Surgery (WSPCHS) / European Congenital Heart Surgeons Association (ECHSA) 2026 (1) Clinical Practice Guidelines on Indications and Timing of Pulmonary Valve Replacement in Repaired Tetralogy of Fallot; (2) Expert Consensus Document on Timing, Indications, and Options for Pulmonary Valve Replacement in Children with Repaired Tetralogy of Fallot; and (3) Expert Opinion on The Role of Exercise Testing in Determining Optimal Timing of Pulmonary Valve Replacement in Tetralogy of Fallot.

Abstract

Pulmonary valve replacement (PVR) is a common and critical intervention for patients with repaired tetralogy of Fallot (TOF) and clinically significant pulmonary regurgitation. The Society of Thoracic Surgeons (STS) collaborated with The World Society for Pediatric and Congenital Heart Surgery (WSPCHS) and The European Congenital Heart Surgeons Association (ECHSA) to produce three multi-societal evidence-based manuscripts: (1) Clinical Practice Guidelines (CPG) on Indications and Timing of Pulmonary Valve Replacement in Repaired Tetralogy of Fallot; (2) Expert Consensus Document (ECD) on Timing, Indications, and Options for Pulmonary Valve Replacement in Children with Repaired Tetralogy of Fallot; and (3) Expert Opinion ("White Paper") on The Role of Exercise Testing in Determining Optimal Timing of Pulmonary Valve Replacement in Tetralogy of Fallot. The purpose of this Executive Summary is to summarize the associated consensus-based recommendations from the CPG, consensus-based statements from the ECD, and consensus-based expert opinions from the "White Paper". This collection of documents provides an updated framework for decision-making about PVR for patients with repaired TOF. Key considerations include the status of symptoms, ventricular volumes and function, and procedural risks, with emerging evidence supporting tailored strategies of intervention. Future research should focus on comparing timing and long-term outcomes for transcatheter versus open surgical PVR, particularly in pediatric and adolescent populations.