Repair of numerous complex congenital cardiac anomalies have been made possible utilizing tissue valves and valved conduits for the repair of the right ventricular outflow tract. Most of these patients are now surviving well into adulthood. Intraoperative and postoperative complications following right ventricular outflow (RVOT) tract reconstruction are not rare. Most of these complications are treatable and many, if not most, are preventable. Tissue pulmonary prosthesis durability is limited necessitating the need for multiple reoperations during the patient’s lifespan. Percutaneous pulmonary valve replacements have reduced the number of open surgical procedures but will not eliminate the need for repeat surgery. Progress is being made and will continue to be made. This chapter will focus on the management of many of the surgical complications of RVOT reconstruction using several prostheses.