Transcatheter Pulmonary Valve Replacement in Dysfunctional Valved Polytetrafluoroethylene (PTFE) Right Ventricular Outflow Tract Conduits

Transcatheter conduit rehabilitation and pulmonary valve replacement (TPVR) are standard of care in the management of right ventricular outflow tract (RVOT) conduit dysfunction. There is a paucity of data on TPVR in polytetrafluoroethylene (PTFE) valved RVOT conduits. We aim to compare safety and efficacy of TPVR in PTFE to homograft RVOT conduits. Single center retrospective study of patients with a PTFE or homograft RVOT conduit who underwent TPVR from 2010 to 2021. Outcomes included change in conduit diameter and gradient and freedom from conduit injury. TPVR was performed in 56 patients with either a PTFE (n = 18) or homograft (n = 38) RVOT conduit. The PTFE group was younger (median 11.7 vs. 22.8 years; p < 0.001), smaller (median 36.5 vs. 71.5 kg; p = 0.002), and had smaller pre-intervention conduit diameter (median 10.9 vs. 13 mm; p = 0.02). Both groups were comparable in degree of baseline stenosis and gradient reduction, with greater increase in conduit diameter from nominal to post-intervention in the PTFE group (107.5% vs. 100%, p = 0.03). Overall, 13% (n = 7) of patients manifested conduit injury, with only 1 in the PTFE group (6% vs. 16%; p = 0.28). The safety and efficacy profiles of TPVR in PTFE and homograft RVOT conduits were similar. Despite smaller nominal diameters in the PTFE cohort, overdilation to accommodate TPVR is feasible without increased evidence of conduit injury.