INVASIVE INTERVENTIONS IN STRUCTURAL HEART DISEASES: COMPREHENSIVE TECHNIQUES

Invasive Interventions in Structural Heart Diseases-kapak

TRANSCATHETER PULMONARY VALVE REPLACEMENT

Serdar Fırtına

Gülhane Training and Research Hospital, Department of Cardiology, Ankara, Türkiye

Fırtına S. Transcatheter Pulmonary Valve Replacement. In: Tanık VO, Özlek B, editors. Invasive Interventions in Structural Heart Diseases: Comprehensive Techniques. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.377-385.

ABSTRACT

Transcatheter pulmonary valve replacement (TPVR) is a minimally invasive treatment option for a degenerated prosthetic pulmonary valve or pulmonary conduit in patients with complex structural heart disease who have previously undergone corrective surgery. TPVR has demonstrated low morbidity and mortality rates compared to surgical procedures, with very successful shortand intermediate-term outcomes. Transcatheter aortic valve procedures have pioneered the transcatheter pulmonary valve implantation procedure. More than a decade has passed since the first pulmonary valve implantation in 2010. Today, with advancements in valve technologies (balloon-expandable or self-expandable valves) and catheterization techniques, the treatment of pulmonary valve dysfunction using transcatheter methods is successfully performed worldwide. TPVR is indicated for patients with pulmonary valve pathology (stenosis, regurgitation, or both), especially those with complex congenital heart anomalies and multiple comorbidities or previous corrective surgical operations. Comprehensive patient evaluation is important. Cardiac computed tomography is crucial for accurately understanding the RVOT and pulmonary valve anatomy. TPVR is performed under general anesthesia and fluoroscopic guidance through peripheral venous access. Both pre-stenting and direct valve implantation techniques are successfully performed with accurate anatomical evaluation and appropriate patient selection. Various valve designs are available today for TPVR. Like any invasive procedure, TPVR carries a risk of complications, including vascular access-related issues, conduit or valve rupture, device embolization, endocarditis, stent fracture, rhythm problems, and paravalvular leaks. Comprehensive patient evaluation, procedural planning with appropriate technique and device selection, will help minimize the risk of these complications. TPVR has emerged as a groundbreaking alternative to traditional surgical valve replacement in the management of pulmonary valve diseases, providing less invasive and highly effective treatment. Studies have demonstrated the efficacy and safety of TPVR. Shorter hospital stays, reduced procedural risk, and improved quality of life by optimizing pulmonary valve hemodynamics are critical outcomes of the procedure. Advancements in device and valve technology and procedural techniques will further improve TPVR outcomes.

Keywords: Pulmonary valve stenosis; Pulmonary valve insufficiency; Heart valve prosthesis implantation; Heart defects, congenital; Transcatheter aortic valve replacement

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