The Society of Thoracic Surgeons (STS)/World Society for Pediatric and Congenital Heart Surgery (WSPCHS)/European Congenital Heart Surgeons Association (ECHSA) Expert Opinion on the Role of Exercise Testing in Determining Optimal Timing of Pulmonary Valve Replacement in Tetralogy of Fallot

Background Optimal timing of pulmonary valve replacement (PVR) after surgical repair of tetralogy of Fallot remains uncertain. Cardiopulmonary exercise testing (CPET) has been proposed as a tool in determining timing, but clear guidelines are lacking. Methods The Society of Thoracic Surgeons (STS) Workforce on Evidence-Based Surgery, in collaboration with the World Society for Pediatric and Congenital Heart Surgery and European Congenital Heart Surgeons Association, convened a writing committee to review available literature and compile expert opinions on the role of CPET in the timing of PVR. Results After the committee reviewed and extracted data from 17 articles, expert opinions were agreed upon, including the following: (1) CPET is a useful tool in assessing patients’ cardiorespiratory system in a dynamic state but requires knowledge and experience to perform and interpret the results; (2) CPET provides prognostic information for patients with tetralogy of Fallot, but optimal use in the timing of PVR remains unclear and varies based on specific patient scenarios; and (3) further research is needed to define optimal CPET variables and thresholds for action. Conclusions CPET is an important adjunct in evaluating patients after surgical repair of tetralogy of Fallot, but optimal use requires further research.