Longitudinal incisions are made in the arteries' anterior and posterior walls. Strips of redundant aneurysmal tissue are excised, and the incisions are closed. The pulmonary regurgitation is addressed with a monocusp or a homograft valve. Older patients may tolerate some pulmonary regurgitation without valve placement. The remaining elements of the TOF repair, the VSD closure and transannular patching of the RV outflow tract, are performed.
Mortality is higher in patients who are symptomatic early and younger at the time of operation.
In spite of good surgical results, chronic respiratory failure due to bronchomalacia and bronchospasm may ensue. Tracheobronchopexy procedures and endobronchial stents have been used. Sometimes long-term mechanical ventilation with PEEP is required. While operations for both isolated TOF and isolated AV canal are relatively low-risk procedures, the combination of the two lesions has implications for higher mortality and more postoperative problems. Following repair of the common AV valve, tricuspid regurgitation is common.