Percutaneous Pulmonary Valve Implantation With Balloon‐Expandable Valves for Management of Dysfunctional Different Right Ventricular Outflow Tracts

Introduction Percutaneous pulmonary valve implantation (PPVI) has been approved for the management of the dysfunctional pulmonary valve (PV) and right ventricular outflow tract (RVOT). The study aimed to evaluate the feasibility, safety, and efficacy of the balloon‐expandable valves in PPVI for the management of dysfunctional different RVOTs with pulmonary stenosis (PS) and/or pulmonary regurgitation (PR) and to compare PPVI between RV‐PA conduits/bioprosthetic PVs and native/patched RVOTs regarding the preprocedure, procedural, postprocedural characteristics, and long‐term outcome. Methods All patients who underwent PPVI for dysfunctional different RVOTs using balloon‐expandable valves, either Melody or Sapien S3 valves, from May 2017 to January 2025 were included. Results Forty‐two patients underwent PPVI; 24 (57.1%) had RV‐PA conduits/bioprosthetic PVs, and 18 (42.9%) had native/patched RVOTs. The mean age and weight were 29.9 ± 13.7 years and 65.4 ± 23.6 kg, respectively. Cardiac MRI revealed the RVEDVI of 144.9 ± 32.9 mL/m 2 , RVEF of 48.6 ± 7.1%, and PV‐Pg of 33.5 ± 20.3 mmHg. Three (7.1%) patients with bioprosthetic PVs underwent direct valve implantation; 21 (50.0%) patients required 1 stent, 15 (35.7%) required 2 stents, and 2 (4.8%) from the native/patched RVOT group required the Russian Doll technique. The Melody valve was implanted in 7 (16.7%) patients, and the Edwards Sapien S3 valve was implanted in 35 (83.3%) patients. Larger balloons, longer and multiple stents, with larger valves were required in native/patched RVOTs ( p < 0.001 ∗ ). All patients reported technical success, with mean procedural and fluoroscopy times of 56.7 ± 6.9 and 37.8 ± 7.3 min. No patient suffered coronary impingement with a total in‐hospital stay of 2.3 ± 1.0 days, without recorded mortality. Conclusions PPVI using balloon‐expandable valves is a feasible and safe method for managing dysfunctional RVOTs: RV‐PA conduits, bioprosthetic PVs, native, and patched RVOTs. However, preprocedural characteristics, procedural strategies, technical approaches, valve sizing methods, materials used, and outcomes vary according to the RVOT anatomy.