Medical Student University of Toronto Toronto, Ontario, Canada
Background: Transcatheter pulmonary valve implantation (TPVI) offers a minimally invasive treatment option for right ventricular outflow tract (RVOT) dysfunction after the Ross procedure. Given the paucity of data regarding its clinical outcomes, we reviewed the safety, efficacy, and durability of TPVI in this context.
METHODS AND RESULTS: This retrospective observational study was conducted at a single large tertiary academic centre. Using a prospectively collected database, we identified all adult patients (aged >18 years) who underwent TPVI following a previous Ross procedure. Data collection through detailed chart reviews included demographics, indications for TPVI, procedural details, pre- and post-procedural echocardiography, and pre- and post-implantation right heart pressures as determined by catheterization. Outcomes assessed included technical procedural success, changes in pressure gradients across the right ventricle to pulmonary artery (RV-PA) conduit, complications, and follow-up echocardiographic findings.
Between 2009 and 2024, 162 patients underwent TPVI. Of these, 20 (80% male) had previously undergone a Ross procedure. Median age at the time of index TPVI was 36 (IQR 24–56) years. Median interval from Ross procedure to index TPVI was 19 (IQR 5–24) years. Primary indications for intervention were RV-PA conduit stenosis (n=14, 70%), regurgitation (n=4, 20%), or both (n=2, 10%). Technical success was achieved in 19 (95%) cases. One case was converted to a surgical pulmonary valve replacement due to valve embolization in the RVOT. Procedural hemodynamics showed a decrease in the peak-to-peak RV-PA gradient from 34±16 mmHg to 9±6 mmHg (p < 0.00001) and the systolic RV-systemic pressure ratio from 0.6±0.1 to 0.4±0.1 (p < 0.0001). By transthoracic echocardiography, mean peak RV-PA conduit gradient decreased from 58.8 ± 25.8 mmHg pre-TPVI to 36.6 ± 13.9 mmHg at discharge (p = 0.0035). No patient experienced major adverse cardiovascular events or clinically significant pulmonary valve regurgitation post-procedure. At a median follow-up of 23 (IQR 2–39) months, 19 patients were alive, and one had required reintervention via balloon valvuloplasty.
Conclusion: Despite comprising a relatively small cohort, our study is one of the largest and only of its kind. It demonstrates that TPVI is a safe and effective intervention — with promising mid-term outcomes — for failing RV-PA conduits following pulmonary autograft harvesting. Routine transcatheter treatment of RVOT dysfunction may further favour use of the Ross procedure by offering a minimally invasive strategy to address one of its main limitations.
