Adult Transcatheter Pulmonary Valve Replacement

Abstract

Transcatheter pulmonary valve replacement (TPVR) is one of the structural interventions developed over the past 25 years. It is being used for patients with moderate to severe pulmonary stenosis and regurgitation. It is an alternative and preferred option to surgical pulmonary valve replacement (SPVR). Common indications include isolated congenital native valve pulmonary stenosis, right ventricular outflow tract obstruction with or without right ventricular conduit stenosis, severe pulmonary regurgitation with right ventricular dysfunctions, and lastly, bioprosthetic pulmonary valve dysfunctions. TPVR is a complex procedure that requires invasive hemodynamic assessments, a balloon test to exclude coronary artery compressions, and preprocedural right ventricular outflow tract preparation with balloon dilation and stenting. Once access to the pulmonary valve is established and the catheter is positioned in the preferred landing zone, bioprosthetic valves, compressed into various delivery systems, are deployed using fluoroscopy guidance. Currently, there are 7, either balloon-inflated or self-expanding, bioprosthetic valves with different sizes and delivery systems. Conduit rupture and coronary artery compressions are the 2 most feared but less common complications of the procedure, while stent fracture, infective endocarditis, and arrhythmias are among the short- and long-term complications. Unlike the transcutaneous aortic valve replacement for aortic stenosis, TPVR is not an extensively studied procedure. Limited observational studies and meta-analyses have indicated a survival rate of 95%. Compared with SPVR, it has a similar risk of reinterventions with no difference in mortality. However, it has an increased risk of infective endocarditis and may incur slightly more cost than SPVR.

Keywords: balloon valvuloplasty; pulmonary stenosis; right ventricular outflow tract obstruction; transcatheter pulmonary valve replacement.