The Society of Thoracic Surgeons / World Society for Pediatric and Congenital Heart Surgery / European Congenital Heart Surgeons Association 2026 Expert Consensus Document on Timing, Indications, and Options for Pulmonary Valve Replacement in Children With Repaired Tetralogy of Fallot

This 2026 joint expert consensus document from the Society of Thoracic Surgeons (STS), the World Society for Pediatric and Congenital Heart Surgery, and the European Congenital Heart Surgeons Association addresses a longstanding gap in pediatric guidance. While indications and timing for pulmonary valve replacement (PVR) are well established in adults with repaired tetralogy of Fallot, no comparable framework has existed for children living with chronic pulmonary regurgitation. A multidisciplinary panel of congenital surgeons and cardiologists, convened by the STS Workforce on Evidence-Based Surgery, combined a focused literature review with a modified Delphi process to reach consensus on 13 recommendations, organized around two themes: pediatric-specific considerations and the choice between surgical versus transcatheter PVR techniques. The resulting document offers congenital heart teams practical, expert-derived guidance for navigating the complex decision of when and how to intervene on chronic pulmonary regurgitation in this population, aiming to optimize right ventricular preservation ahead of eventual valve replacement.