Updates on transcatheter pulmonary valve replacement

Abstract

In the 20 years following the first described transcatheter pulmonary valve replacement (TPVR), there has been significant progress made in understanding the application and performance of this technology. For the Melody TPV (Medtronic, Minneapolis, MN) there is now over 10 years of follow-up data from prospective studies and multicenter registries that provide insight on acute procedural results, long-term valve performance, and risks to valve function such as stent fracture and infection. For the Sapien XT and S3 valves (Edwards Lifesciences, Irvine, CA) the duration of follow-up is shorter, but the breadth of experience is growing. Our understanding of procedural risks such a conduit injury and coronary compression has improved, as have our techniques for managing these potential complications. Studies have demonstrated that small conduits can be over-expanded and small bioprosthetic valves can be fractured to extend TPVR to a broader population of patients than originally envisioned. TPVR has been successfully applied to the patient with the native or patched right ventricular outflow tract (RVOT) and our understanding of pre-procedural imaging and screening for the native RVOT continues to improve. Future investigations should focus on the impact of TPVR on survival and long term health of the right ventricle as well as identifying and reducing risk factors that lead to infective endocarditis which continues to be a challenge in this patient population.