Key result
Transcatheter valve replacement in adult congenital heart disease carries ~35% 10-year risk of reintervention.
Why the study?
This study aimed to describe outcomes after transcatheter valve replacement in adults with congenital heart disease.
Cohort (n=341)
No
Transcatheter valve replacement in adults with congenital heart disease is associated with early clinical improvement across multiple domains, but faces significant long-term limitations with a 35% incidence of reintervention at 10 years due to progressive prosthesis deterioration.
Answers are grounded in this paper and cite their sources.
Urges caution on expected prosthesis durability in adults with congenital heart disease; extends sparse long-term observational data but leaves optimal device selection open.
BACKGROUND: The current study aims to describe outcomes after transcatheter valve replacement in adults with congenital heart disease. METHODS: Retrospective study of adults with congenital heart disease who underwent transcatheter valve replacement and had a 1-year follow-up postintervention at Mayo Clinic (2010–2024). The study period was divided into early (2010–2014), mid (2015–2019), and late (2020–2024) eras. The primary outcome was valve reintervention. The secondary outcomes were all-cause mortality and temporal change in prosthetic valve gradient and clinical indices of disease severity. RESULTS: Overall, 341 patients (age 38±17 years; 175 [51%] men) received 346 prostheses (pulmonary [N=236, 68%], tricuspid [N=75, 22%], aortic [N=22, 8%], and mitral [N=7, 2%]). The prostheses were Sapien (N=181, 52%), Melody (N=142, 41%), and Harmony prostheses (N=23, 7%). The number of transcatheter valve implantations increased from the early era (N=75), mid era (N=109), to the late era (N=162). The 10-year incidence of valve reintervention was 35%, and was similar between Sapien versus Melody prosthesis (41% versus 33%; P =0.11). The 10-year incidence of all-cause mortality was 13%. There was a temporal increase in prosthetic valve Doppler mean gradient (baseline versus 10 years) for pulmonary (12±5 versus 28±11 mmHg; P <0.001), tricuspid (3±1 versus 8±3 mmHg; P <0.001), and aortic prosthesis (13±5 versus 26±12 mmHg; P <0.001). There was a temporal increase in predicted peak oxygen consumption (absolute ∆, 9% [95% CI, 4–13]; P =0.006) and a decrease in NT-proBNP (N-terminal pro-B-type natriuretic peptide) level (absolute ∆, −138 pg/mL [95% CI, −209 to −64]; P <0.001) at 1-year postintervention. CONCLUSIONS: There has been a temporal increase in the number of transcatheter valve implantations over time. Transcatheter valve replacement was associated with clinical improvement across multiple domains. However, there was a significant increase in prosthetic valve gradient within 10 years of follow-up, suggesting limited prosthesis longevity. There is a need for strategies to improve prosthetic valve longevity, which in turn may improve outcomes in this population.
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Egbe et al. (2025) conducted a cohort in Congenital heart disease with valvular heart disease (n=341). Transcatheter valve replacement was evaluated on Incidence of valve reintervention for prosthetic valve dysfunction. Transcatheter valve replacement in adults with congenital heart disease was associated with a 35% 10-year incidence of valve reintervention, highlighting concerns regarding prosthesis longevity.
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