Key result
Transcatheter pulmonary valve replacement cuts mortality ~36% vs surgery but raises infective endocarditis risk.
Why the study?
Although transcatheter pulmonary valve replacement was developed as a minimally invasive alternative to re-do surgery, its comparative effects on patient outcomes were less clear.
Does transcatheter pulmonary valve replacement reduce mortality and complications compared to surgical pulmonary valve replacement in patients with pulmonary valve or right ventricular outflow tract dysfunctions?
Meta-Analysis (n=16,150)
Yes
Does transcatheter pulmonary valve replacement reduce mortality and complications compared to surgical pulmonary valve replacement in patients with pulmonary valve or right ventricular outflow tract dysfunctions?
Effect estimate: OR 0.64 (95% CI 0.43, 0.95)
TPVR offers a survival benefit over surgical replacement but is associated with a significantly higher risk of infective endocarditis.
TPVR may be considered for mortality reduction in suitable patients; extends comparative evidence while underscoring threefold endocarditis risk.
INTRODUCTION: Transcatheter pulmonary valve replacement (TPVR) is developed as a non-surgical, minimally invasive procedure to reduce the need for re-do cardiac surgical interventions. However, its impacts on patient outcomes are less clear. This study aims to investigate the effects of TPVR among patients with pulmonary valve or right ventricular outflow tract dysfunctions. MATERIALS AND METHODS: In this systematic review and meta-analysis, we searched PubMed, Cochrane CENTRAL, EMBASE, CINAHL Complete, and Web of Science, from database inception to March 1, 2024, to identify studies that assessed the comparative effectiveness of transcatheter pulmonary valve replacement (TPVR) and surgical pulmonary valve replacement (SPVR). The key outcomes of interest included mortality, pulmonary regurgitation (PR), infective endocarditis (IE), re-intervention, improvements in cardiac failure based on the New York Heart Association (NYHA) functional classification, and adverse events. Meta-analyses using a random-effects model were performed. RESULTS: A total of 28 studies (n = 16,150) were included. The meta-analyses depicted that when compared with SPVR, TPVR reduced risks of mortality by 36% (odds ratio [OR] = 0.64 [95% confidence interval, CI: 0.43, 0.95]), but conferred a three-fold greater odd of IE over the follow-up duration (OR = 3.10 [95% CI: 2.22, 4.33]). No significant differences were observed for 30-day mortality, and the early PR, IE and re-intervention, as well as the PR and re-intervention during follow-up. Meta-analyzed results across the outcome measures varied according to geographical region, publication year cut-off, and income status of country. All patients who had undergone valve replacement showed improvements in heart function and experienced relevant post-procedural complications. CONCLUSIONS: TPVR afforded significant clinical benefits in patient survival, but nonetheless, it was associated with an elevated risk for infective endocarditis.
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Chongmelaxme et al. (2025) conducted a meta-analysis in Pulmonary valve or right ventricular outflow tract dysfunctions (n=16,150). Transcatheter pulmonary valve replacement (TPVR) vs. Surgical pulmonary valve replacement (SPVR) was evaluated on Mortality (OR 0.64, 95% CI 0.43, 0.95). Transcatheter pulmonary valve replacement reduced mortality by 36% compared with surgical replacement (OR 0.64; 95% CI 0.43-0.95), but conferred a three-fold greater odds of infective endocarditis.
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