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. 2022 Aug 2;1(5):100408.
doi: 10.1016/j.jscai.2022.100408. eCollection 2022 Sep-Oct.

Outcomes of Transcatheter Pulmonary Valve Replacement and Surgical Pulmonary Valve Replacement: A Cohort Analysis

Kritvikrom Durongpisitkul  1 , Ekkachai Dangrungroj  2 , Paweena Chungsomprasong  1 , Chodchanok Vijarnsorn  1 , Prakul Chanthong  1 , Thita Pacharapakornpong  1 , Supaluck Kanjanauthai  1 , Jarupim Soongswang  1 , Porntip Panjasamanvong  3 , Pornrawee Plearntummakun  3 , Teerapong Tocharoenchok  4 , Ekarat Nitiyarom  4 , Kriangkrai Tantiwongkosri  4 , Punnarerk Thongcharoen  4 , Thaworn Subtaweesin  4 , Somchai Sriyoschati  4
Affiliations

Outcomes of Transcatheter Pulmonary Valve Replacement and Surgical Pulmonary Valve Replacement: A Cohort Analysis

Kritvikrom Durongpisitkul et al. J Soc Cardiovasc Angiogr Interv. .

Abstract

Background: Transcatheter pulmonary valve replacement (TPVR) has become an alternative to surgical pulmonary valve placement (SPVR) for patients after tetralogy of Fallot repair. This study compared the outcomes of TPVR with those of SPVR.

Methods: We reviewed data from patients who underwent pulmonary valve replacement with a median of 2 years of follow-up.

Results: Between 2010 and 2021, 215 patients underwent pulmonary valve replacement (72 TPVR and 143 SPVR). The median size of the right ventricular end-diastolic volume index in the TPVR group was 165 mL/m2 (IQR, 136-190) and 184 mL/m2 (IQR, 163-230) in the SPVR group (P = .001). The median value of the maximum landing zone at the right ventricular outflow tract (RVOT) in patients with native RVOT was 26 mm (IQR, 24-28) in the 43 patients in the TPVR group and 31 mm (IQR, 28-34) in the 101 patients in the SPVR group (P < .001). The median size of the pulmonary valve implant for the native RVOT in the TPVR group was 29.0 mm (IQR, 26.0-29.0) and 24.0 mm (IQR, 24.0-24.0) in the SPVR group (P < .001). There were no deaths in the TPVR group and 8 deaths in the SPVR group (P = .041). Major complications and the length of hospitalization were lower in the TPVR group (P = .001). After 2 years, the mean decrease in QRS duration was 5 milliseconds (IQR, 1-14) in the TPVR group and 1 millisecond (IQR, -4 to 10) in the SPVR group (P = .006).

Conclusions: TPVR allows for larger implants, resulting in lower mortality, shorter hospital stays, and fewer major cardiac events. SPVR may be preferable in patients with larger (>30 mm) native RVOT and in those who require concomitant surgical procedures.

Keywords: surgical pulmonary valve replacement; tetralogy of Fallot; transcatheter pulmonary valve replacement.

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Figures

None
Graphical abstract
Figure 1
Figure 1
Angiography showing steps of transcatheter pulmonary valve replacment. (A) Angiography in RAO delineated PV landing zone and MPA, RPA and LPA, and RV. (B) Angiography in RAO view showing balloon sizing using a 30-mm PTS-X balloon (NuMed Inc) with simultaneous right ventricular angiography. (C) An example of postimplantation of 29-mm Edward SAPIEN 3 at PV area with main pulmonary artery angiography showing that the implanted valve is competent. LPA, left pulmonary artery; MPA, main pulmonary artery; PV, pulmonary valve; RAO, right anterior oblique; RPA, right pulmonary artery; RV, right ventricle.
Central Illustration
Central Illustration
Comparison of proportion and severity of PR between TPVR and SPVR, preprocedure (denoted by “pre_”), immediately postoperative, and at 1 and 2 years. The number of patients in each degree of PR is also shown. The degree of PR is shown as none, mild, moderate, or severe. PR, pulmonary regurgitation; SPVR, surgical pulmonary valve replacement; TPVR, transcatheter pulmonary valve replacement.
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