Feasibility of Self-Expanding Transcatheter Pulmonary Valves in Patients with Pyramidal RVOT: Favorable Mid-term Outcomes

Transcatheter pulmonary valve replacement (TPVR) is effective for treating significant pulmonary regurgitation (PR), but mid-term data in patients with pyramidal right ventricular outflow tract (RVOT) anatomy are limited. This multi-center retrospective study included patients who underwent TPVR between May 2014 and September 2023. Baseline and echocardiographic data were compared between patients with pyramidal and non-pyramidal RVOT. The primary endpoint was peri-procedural device success, defined as technical success, optimal valve function on discharge echocardiography (RVOT gradient < 30 mmHg, less than moderate PR, no significant paravalvular leak), and absence of in-hospital mortality or re-intervention. The secondary endpoint was 1-year freedom from all-cause mortality, cardiac hospitalization, endocarditis, significant stent fracture, valve dysfunction, and device-related re-intervention. Sixty-eight patients were enrolled. Device success was achieved in 86.7% of pyramidal RVOT patients and 100% of non-pyramidal patients (P = 0.067). At 1 year, no significant difference was observed in the composite secondary endpoint (91.7% vs. 86.0%, P = 0.605). Both groups showed similar improvements in echocardiographic and clinical outcomes. Additionally, no statistically significant differences were observed between the two groups regarding post-TPVR regurgitation and paravalvular leakage. TPVR using self-expanding valves in pyramidal RVOT showed acceptable device success rates and favorable mid-term outcomes in both clinical and hemodynamic parameters. Morphology-based pre-procedural planning is essential for optimizing results.