Transcatheter pulmonic valve implantation: Techniques, current roles, and future implications

Abstract

Right ventricular outflow tract (RVOT) obstruction is present in a variety of congenital heart disease states including tetralogy of Fallot, pulmonary atresia/stenosis and other conotruncal abnormalities etc. After surgical repair, these patients develop RVOT residual abnormalities of pulmonic stenosis and/or insufficiency of their native outflow tract or right ventricle to pulmonary artery conduit. There are also sequelae of other surgeries like the Ross operation for aortic valve disease that lead to right ventricle to pulmonary artery conduit dysfunction. Surgical pulmonic valve replacement (SPVR) has been the mainstay for these patients and is considered standard of care. Transcatheter pulmonic valve implantation (TPVI) was first reported in 2000 and has made strides as a comparable alternative to SPVR, being approved in the United States in 2010. We provide a comprehensive review in this space–indications for TPVI, detailed procedural facets and up-to-date review of the literature regarding outcomes of TPVI. TPVI has been shown to have favorable medium-term outcomes free of re-interventions especially after the adoption of the practice of pre-stenting the RVOT. Procedural mortality and complications are uncommon. With more experience, recognition of risk of dreaded outcomes like coronary compression has improved. Also, conduit rupture is increasingly being managed with transcatheter tools. Questions over endocarditis risk still prevail in the TPVI population. Head-to-head comparisons to SPVR are still limited but available data suggests equivalence. We also discuss newer valve technologies that have limited data currently and may have more applicability for treatment of native dysfunctional RVOT substrates.

Role of computed tomography in transcatheter replacement of ‘other valves’: a comprehensive review of preprocedural imaging

“…Stenosis and regurgitation of the pulmonary valve are common defects in congenital heart disease associated with right ventricular outflow tract (RVOT) abnormalities; moreover, pulmonary valve disease and RVOT dysfunction may result from surgery for congenital heart disease or occur as a consequence of acquired conditions such as bacterial endocarditis, carcinoid heart disease and rheumatic heart disease 79–82 …”

“…79 Stenosis and regurgitation of the pulmonary valve are common defects in congenital heart disease associated with right ventricular outflow tract (RVOT) abnormalities; moreover, pulmonary valve disease and RVOT dysfunction may result from surgery for congenital heart disease or occur as a consequence of acquired conditions such as bacterial endocarditis, carcinoid heart disease and rheumatic heart disease. [79][80][81][82] Although in the past, study of the pulmonary valve and RVOT was exclusively performed using transthoracic and transesophageal echocardiography, in recent years, CT has progressively replaced echocardiography by providing an accurate preoperative assessment of anatomical details of the pulmonary valve, perivalvular structures and RVOT. [83][84][85] This preliminary evaluation is crucial to reduce complications (stent migration, stent fracture, conduit rupture, coronary artery compression and pulmonary haemorrhage) 86 and to guide the percutaneous procedure by the use of 3D roadmaps created from CT data sets.…”

Multimodality Imaging of the Neglected Valve: Role of Echocardiography, Cardiac Magnetic Resonance and Cardiac Computed Tomography in Pulmonary Stenosis and Regurgitation

“…Transcatheter pulmonary valve implantation is a non-surgical option in patients with PS or PR, also after previous cardiac intervention such as right ventricle–to–pulmonary artery conduit [ 10 , 11 ]. The main advantage of this approach is the less invasive nature compared to surgery.…”