Transcatheter Pulmonary Valve Replacement in the Native Dysfunctional Right Ventricular Outflow Tract: Strategies for Optimal Prosthesis Selection, Valve Deployment and Lifetime Management

The dysfunctional native right ventricular outflow tract presents unique challenges for transcatheter valve replacement due to its anatomical heterogeneity. Technological advancements, coupled with expanding experience across diverse valve platforms have broadened patient eligibility and facilitated a tailored approach to prosthesis selection. This article provides a practical overview of the Edwards Sapien valve series, the Alterra Adaptive Prestent with the Sapien valve, the Venus P-valve, and the Harmony transcatheter pulmonary valve, with a focus on device design, sizing approach, procedural strategies and contemporary outcomes. Additionally, we highlight key considerations for valve selection and deployment according to variations in right ventricular outflow tract and branch pulmonary artery anatomy. Given these patients are often relatively young, we also discuss clinical issues related to transcatheter pulmonary valve replacement and lifetime management.