Percutaneous pulmonary valve implantation: Long term outcomes

Percutaneous pulmonary valve implantation (PPVI) is effective to treat right ventricle outflow (RVOT) dysfunction. Long term results and risk factors of valve dysfunction remain little known. We studied long term results of PPVI. All consecutive patients who had successful PPVI between January 2008 and January 2020 in one tertiary center were prospectively included. Follow-up was updated in 2020. 212 patients were included (Melody Valve, n = 32 (15.1%); Sapien XT Valve, n = 47 (22.2%); Sapien 3 valve, n = 133 (62.7%). Median age was 28 years (range 10-81). Patched native pulmonary artery was the most frequent RVOT type (44.4%). Mean follow-up was 2.8 years (range 3 months to 11.4 years). Pulmonary valve replacement (PVR) was performed in 23 cases (10.8%), related to stenotic degeneration ( n = 22 cases, 95%) and severe regurgitation ( n = 1, 4.3%). PVR was performed in 17 Melody valves (53.1%) and 6 Sapien valves (3.3%), with an incidence of 7.6% per patient-year and 1.3% per patient-year respectively ( P = 0.05). Mean interval between PPVI and PVR was 4.7 years (range 1.1-10.1 year). Infective endocarditis (IE) was reported in 13 patients (Melody valve, n = 12, 37.5%; Sapien valve, n = 1, 0.5%) with an incidence of 5.5% per patient-year and 0.2% per patient-year respectively ( P < 0.0001). In an univariate Cox regression analysis, risk factors of PVR were RV obstruction before PPVI ( P = 0.04), transpulmonary maximal velocity > 2.7 m/s after PPVI ( P = 0.05), tricuspid regurgitation doppler maximal gradient >50 mmHg after PPVI ( P < 0.001), valve diameter < 22 mm ( P < 0.003), IE ( P < 0.0001) and age < 25 ( P = 0.04). Risk factors of IE were Melody valve ( P < 0.0001), RV obstruction before ( P = 0.03) or after PPVI ( P = 0.05), valve diameter < 22 mm ( P < 0.03), and younger age ( P = 0.02). PPVI is effective to treat RVOT dysfunction. Implanted Valve durability is shorter when residual RV obstruction is observed, in smaller RVOT, and when IE occurs.