Pulmonary Valve Replacement: A Single-Institution Comparison of Surgical and Transcatheter Valves

Background: Transcatheter pulmonary valve replacement (TPVR) is increasingly utilized to address residual or recurrent right ventricular outflow tract pathology in congenital heart disease patients. We aimed to evaluate clinical outcomes and resource utilization comparing TPVR to surgical pulmonary valve replacement (SPVR) for this patient population.

Methods: From January 2010 until December 2015, 224 patients underwent pulmonary valve replacement (SPVR = 100 and TPVR = 124). These groups were assessed and compared for survival, reoperation, reintervention (surgical or catheter based), hospital costs, and hemodynamic performance.

Results: There were no mortalities in either group. Despite SPVR patients being significantly younger (12 ± 7 years of age versus 19 ± 13 years of age; p < 0.001) and smaller (body surface area 1.2 ± 0.5 m versus 1.4 ± 0.5 m; p < 0.001), they had similar median valve size implanted (23 mm [interquartile range, 21 to 27 mm) versus 22 mm [interquartile range, 20 to 22 mm]). There was no difference in the adjusted peak gradient (SPVR 24.1 ± 15.1 mm Hg versus TPVR 20.7 ± 11.4 mm Hg; p = 017) at last follow-up. Cumulative freedom from reintervention at 4 years was similar between groups (p = 0.98). TPVR could not be placed in 34 patients either due to coronary compression or excessive outflow tract diameter. SPVR patients had longer hospital length of stay (4.1 ± 1.8 days versus 1.2 ± 0.7 days; p < 0.001). TPVR patients had higher rates of infective endocarditis (4.8% versus 0%; p < 0.001) and overall hospital costs ($57,221 ± $13091 versus $44,366 ± $16,519; p < 0.001).

Conclusions: Hemodynamic performance is similar between SPVR and TPVR with similar rates of reintervention. While SPVR patients have a longer hospital length of stay, TPVR was associated with higher rates of infective endocarditis, hospital costs, and failure to implant.