Progress With New Challenges

BACKGROUND: The Harmony (Medtronic) self-expanding transcatheter pulmonary valve is the first Food and Drug Administration-approved transcatheter valve system designed to treat severe pulmonary regurgitation (PR) in patients with a native or surgically repaired right ventricular outflow tract. The valve greatly expands transcatheter interventions to patients with residual PR after childhood surgical interventions; the risk and treatment of endocarditis with this therapy are still unclear. SUMMARY: In this report, we describe to our knowledge the first published details and images of surgical explantation of this valve with an extensive skirt extending into the right ventricular outflow tract myocardium and pulmonary artery. DISCUSSION: Dissection was difficult and significantly more complex than removal of a standard surgical valve, but it was safely achieved. TAKE-HOME MESSAGE: This case illustrates that although less invasive therapies have intrinsic benefits avoiding repeat open surgery, there may be tradeoffs with more complex surgical explantation that must be factored into timing and selection of valves.