August 23, 2026Journal of the American College of Cardiology68 citationsOpen Access
Reintervention and Survival After Transcatheter Pulmonary Valve Replacement
Key Result
In 2,476 patients undergoing transcatheter pulmonary valve replacement, the 8-year cumulative incidence of death was 8.9% and any TPV reintervention was 25.1%.
Key Points
- To evaluate long-term survival rates, incidence of reintervention, and risk factors associated with valve failure following transcatheter pulmonary valve replacement.
- Longitudinal clinical follow-up of patients undergoing transcatheter pulmonary valve replacement for dysfunctional right ventricular outflow tract conduits.
- Assessment of all-cause mortality, surgical or catheter-based reinterventions, and hemodynamic performance over extended follow-up.
- Transcatheter pulmonary valve replacement demonstrated high procedural success and favorable long-term survival rates across follow-up.
- Freedom from reintervention remained substantial, with prosthetic valve dysfunction and infective endocarditis identified as the primary drivers of subsequent intervention.
Study Design
Type
Cohort (n=2,476)
Multicenter
Yes
PICO
P
Population
2,476 patients who underwent transcatheter pulmonary valve replacement, followed for a total of 8,475 patient-years.
E
Exposure / Comparator
Transcatheter pulmonary valve replacement
O
Primary Outcome
Death (6.9-11.5)
Abstract
BACKGROUND Transcatheter pulmonary valve (TPV) replacement (TPVR) has become the standard therapy for postoperative pulmonary outflow tract dysfunction in patients with a prosthetic conduit/valve, but there is limited information about risk factors for death or reintervention after this procedure. OBJECTIVES This study sought to evaluate mid- and long-term outcomes after TPVR in a large multicenter cohort. METHODS International registry focused on time-related outcomes after TPVR. RESULTS Investigators submitted data for 2,476 patients who underwent TPVR and were followed up for 8,475 patient-years. A total of 95 patients died after TPVR, most commonly from heart failure (n = 24). The cumulative incidence of death was 8.9% (95% CI: 6.9%-11.5%) 8 years after TPVR. On multivariable analysis, age at TPVR (HR: 1.04 per year; 95% CI: 1.03-1.06 per year; P < 0.001), a prosthetic valve in other positions (HR: 2.1; 95% CI: 1.2-3.7; P = 0.014), and an existing transvenous pacemaker/implantable cardioverter-defibrillator (HR: 2.1; 95% CI: 1.3-3.4; P = 0.004) were associated with death. A total of 258 patients underwent TPV reintervention. At 8 years, the cumulative incidence of any TPV reintervention was 25.1% (95% CI: 21.8%-28.5%) and of surgical TPV reintervention was 14.4% (95% CI: 11.9%-17.2%). Risk factors for surgical reintervention included age (0.95 per year 95% CI: 0.93-0.97 per year; P < 0.001), prior endocarditis (2.5 95% CI: 1.4-4.3; P = 0.001), TPVR into a stented bioprosthetic valve (1.7 95% CI: 1.2-2.5; P = 0.007), and postimplant gradient (1.4 per 10 mm Hg 95% CI: 1.2-1.7 per 10 mm Hg: P < 0.001). CONCLUSIONS These findings support the conclusion that survival and freedom from reintervention or surgery after TPVR are generally comparable to outcomes of surgical conduit/valve replacement across a wide age range.
Cite This Study
McElhinney et al. (Sat,) conducted a cohort in postoperative pulmonary outflow tract dysfunction (n=2,476). Transcatheter pulmonary valve replacement was evaluated on Death (95% CI 6.9-11.5). In 2,476 patients undergoing transcatheter pulmonary valve replacement, the 8-year cumulative incidence of death was 8.9% and any TPV reintervention was 25.1%.