Comparative Outcomes of Transcatheter Versus Surgical Pulmonary Valve Replacement in Adults With Congenital Heart Disease

BACKGROUND: Pulmonary valve replacement is frequently required in adults with congenital heart disease (CHD). Comparative real-world outcomes between percutaneous transcatheter pulmonary valve implantation (TPVR) and surgical pulmonary valve replacement (SPVR) remain incompletely characterized. We evaluated outcomes and resource utilization for both approaches. METHODS: Using the National Inpatient Sample (2016-2022), we identified adult CHD patients undergoing TPVR or SPVR. The primary outcome was in-hospital mortality. Secondary outcomes included acute kidney injury (AKI), infection, mechanical circulatory support (MCS), and any major complication. Survey-weighted logistic regression assessed associations with outcomes, adjusting for demographics, comorbidities, and hospital factors. RESULTS: Among 11,285 hospitalizations (31% TPVR, 69% SPVR), overall mortality was 1.7%. Unadjusted mortality was lower for TPVR (1.0% vs. 2.0%, p = 0.095). After adjustment, there was no significant difference in mortality between the treatment arms (adjusted OR 2.64, 95% CI 0.92-7.61; p = 0.072). However, SPVR was associated with significantly higher odds of AKI (adjusted OR 5.39, p < 0.001), infection (adjusted OR 5.96, p < 0.001), and MCS requirement (adjusted OR 130.3, p < 0.001). Any major complication occurred in 95.5% of SPVR versus 35.4% of TPVR patients (adjusted OR 81.2, p < 0.001). TPVR was associated with significantly shorter LOS (2.8 vs. 9.7 days; adjusted difference -6.1 days, p < 0.001) and lower hospitalization charges ($209,918 vs. $336,655; p < 0.001). CONCLUSIONS: In adults with CHD, TPVR was associated with significantly lower complication rates, shorter hospitalization, and reduced cost compared with surgical replacement. While mortality was low for both, substantial differences in morbidity and resource utilization favor TPVR, highlighting the value of transcatheter options.