Safety and Efficacy of Percutaneous Pulmonary Valve Implantation: The Singapore Experience

Abstract

Background: Right ventricular outflow tract (RVOT) dysfunction in adult congenital heart disease patients frequently requires repeated interventions. Percutaneous pulmonary valve implantation (PPVI) is being used increasingly to treat pulmonary stenosis (PS) and regurgitation (PR), improving symptoms, right ventricular haemodynamics and function and, indirectly, left ventricular filling and function. This article explores the authors’ early local experience with PPVI. Methods: Between 2017 and 2022, PPVI was attempted in 10 patients at a single tertiary centre, including six with PS and four with PR. Patients underwent multimodality imaging and dental clearance. PPVI was then performed. Patients were continued on lifelong single antiplatelet therapy and dental hygiene was reinforced. Results: Overall, there was an 80% success rate of Melody PPVI in the 10 adult congenital heart disease (ACHD) patients (mean age 35.8 ± 13.7 years; 60% male), with significant improvements in RVOT pathology, right ventricle function and pulmonary pressures. Melody PPVI was cancelled in one patient due to risk of coronary compression, and an Edwards S3 PPVI was implanted in another patient instead due to a large RVOT size causing stent embolisation. Two patients experienced complications of bleeding and stent fracture, both of which were conservatively managed and had good long-term outcomes. Conclusion: The authors present their early local experience with PPVI in ACHD patients at a single tertiary centre. PPVI has proven to be safe and efficacious, improving PS and PR, right and left ventricle function and pulmonary pressures. Nonetheless, precautions must be taken to minimise complications such as coronary compression, access site bleeding, device embolisation and stent fracture.