Acute and mid-term outcomes of transcatheter pulmonary valve implantation in patients older than 40 years

Abstract

Background: Numerous studies have detailed outcomes of Transcatheter pulmonary valve placement (TPV) in young patients, but there is a paucity of data in older patients. We sought to evaluate short and mid-term outcomes of TPV in patients older than 40 years of age. Methods: Retrospective multicenter study of patients older than 40 years at the time of TPV from January 2010 to February 2018. Demographics, procedure details, and follow up data were collected. Results: A total 75 subjects presented for TPV with median age of 49.8 (IQ 45–60). Half of the patients 39 (52%) had evidence of NYHA class III or IV at time of presentation. A total of 65 (87%) had successful TPV. Patients with severe PR had immediate resolution of PI (except for one). Patients with PS had significant improvement in gradient from median of 25.5 to 5.5 mmHg (p < 0.0001). There were no procedure related deaths. Adverse procedural events occurred in 4 (5%) as 2 procedure related arrhythmias and 2 peripheral vascular injuries. The median follow-up was 2 years (IQ 0.74–3.13). Functional capacity has significantly improved in most patients (p < 0.001). There were 4 (6%) non-procedure related mortalities, 2 (3%) pulmonary valve replacement, and 1 (2%) listed for heart transplant. Four patients (6%) experienced infective endocarditis at a median of 23 months from TPV. Conclusion: TPV in patients older than 40 years is safe and effective. Mid-term follow up demonstrates improvement in functional capacity with stable valvular function, however, infective endocarditis occurred in 6%.

Keywords

• Adult congenital heart disease
• Endocarditis
• Functional capacity
• Right ventricular outflow track