Outcomes of Transcatheter Pulmonary Valve–in–valve Implantation: A Single–centre Observational Study

Background as prevalence of patients with congenital heart disease increases, many patients who have previously undergone pulmonary valve replacement develop dysfunction of the bioprosthesis. Transcatheter pulmonary valve–in–valve implantation (TPViV) is an option of treatment of failing pulmonary bioprosthetic valves, but extensive data are not yet available. Methods we retrospectively analysed 60 patients who underwent TPViV within a failing surgical or percutaneous valve in our Centre since January 2009 to August 2025, collecting procedural data and echocardiographic findings before and after the procedure. Primary outcome at long–term follow–up was a composite of death or reintervention. Results 60 patients were included (mean age 34.1 ±14.6 years; two–thirds male), primarily with an underlying diagnosis of Tetralogy of Fallot (two–thirds) and a history of ≥2 previous cardiac surgeries. The predominant mechanism of valve dysfunction was mixed stenosis and regurgitation. All 60 patients underwent successful TPViV (37 Sapien, 20 Melody and 3 Myval) with no deaths or conversions to open–heart surgery. The procedure significantly reduced peak RVOT gradients (mean reduction 30.7 ±19.5 mmHg, p‹0.001) and right ventricular systolic pressure (mean reduction 25.7 ±19.5 mmHg, p‹0.001), with only one more–than–mild pulmonary regurgitation at discharge. At a mean follow–up of 42.2 months, the composite endpoint of death or reintervention occurred in 17.2% of patients (2 deaths, 8 reinterventions), with infective endocarditis as the main cause. Reintervention–free survival remained ›90% at 1000 days. Conclusions TPViV is a safe and effective strategy for managing dysfunctional pulmonary bioprosthetic valves. Long–term follow–up reinforces that while durability is generally high, endocarditis remains a primary mechanism of late failure requiring reintervention.