Key result
Percutaneous pulmonary valves appear safe while percutaneous aortic valves are linked to high early mortality.
Why the study?
Do percutaneous heart valves improve outcomes compared to conservative medical therapy or traditional surgical valve replacement in patients with degenerative aortic valve and congenital pulmonary outflow tract disease?
Systematic Review
Do percutaneous heart valves improve outcomes compared to conservative medical therapy or traditional surgical valve replacement in patients with degenerative aortic valve and congenital pulmonary outflow tract disease?
Due to safety concerns, percutaneous aortic valve insertion should be restricted to randomized controlled trials, while percutaneous pulmonary valve implantation appears safe enough for conditional reimbursement.
Restrict percutaneous aortic valve insertion to RCTs; supports conditional reimbursement for percutaneous pulmonary valve implantation.
OBJECTIVES: The aim of this study was to assess current evidence supporting the use of percutaneous heart valves (PHV) in degenerative aortic valve and congenital pulmonary outflow tract disease, as compared to conservative medical therapy or traditional surgical valve replacement. METHODS: A systematic review of the literature on PHV was performed. RESULTS: No randomized controlled trials (RCT) on PHV have been published so far. Only observational data from series and data presented at cardiology meetings are available. Both percutaneous aortic valve (PAV) and percutaneous pulmonary valve (PPV) seem feasible in the hands of an experienced team. Safety, however, seems to be a problem in PAV, as shown by the high 30-day and 6-month mortality rates. CONCLUSIONS: Due to safety concerns, PAV reimbursement is not recommended and patients should only be subjected to PAV insertion within the boundaries of an RCT. In contrast, PPV implantation seems to be a safe and promising technology for which reimbursement under strict conditions may be recommended.
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Neyt et al. (2009) conducted a systematic review in Degenerative aortic valve and congenital pulmonary outflow tract disease. Percutaneous heart valves (percutaneous aortic valve and percutaneous pulmonary valve) vs. Conservative medical therapy or traditional surgical valve replacement was evaluated on Feasibility and safety (including 30-day and 6-month mortality). Percutaneous pulmonary valve implantation appears safe, whereas percutaneous aortic valve insertion is associated with high 30-day and 6-month mortality rates and lacks RCT evidence.
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