Multicenter experience of hybrid transcatheter pulmonary valve implantation in patients with a large right ventricular outflow tract

Background Management of pulmonary regurgitation (PR) in patients with a large and dysplastic native right ventricular outflow tract (RVOT) remains a significant challenge for percutaneous intervention. Given the limitations of percutaneous intervention in patients with a large and morphologically complex RVOT, this study aimed to evaluate the safety and efficacy of a hybrid transcatheter pulmonary valve implantation (TPVI) strategy using a self-expanding valve in this patient population. Methods Between June 2021 and December 2023, 102 patients with moderate-to-severe PR and dilated RVOT from 11 centers underwent hybrid TPVI with the Salus transcatheter pulmonary valve (TPV). Procedural strategies, including surgical access and concomitant procedures, were tailored based on comprehensive preoperative assessment. Results The mean age was 22.37 ± 11.15 years (range, 9–66), and 56.9% were male. The most common RVOT morphologies were pyramidal (37.2%) and tubular (30.4%). All procedures were successful. Twenty cases required cardiopulmonary bypass support. There were no intraoperative deaths. One in-hospital death occurred on postoperative day 12 in a high-risk patient with severe preoperative right ventricular dysfunction. All patients completed at least 1 year of follow-up, with a median follow-up duration of 1 year. During this period, significant improvements in right ventricular volumes (RVEDVI and RVESVI) and QRS duration were observed, whereas RVEF did not change significantly. There were no instances of coronary artery compression, valve embolization, or stent fracture. One suspected case of endocarditis was reported. Conclusions In patients with a large and morphologically complex RVOT, hybrid TPVI with the Salus TPV is a safe and effective therapeutic strategy, associated with high procedural success and encouraging short-term outcomes. A patient-specific approach, guided by meticulous preoperative imaging to determine the optimal access and the need for concomitant procedures, is key to minimizing complications. This hybrid technique offers a valuable alternative for patients who are not candidates for percutaneous intervention.