Lurz P et al. (2008) Percutaneous pulmonary valve implantation: impact of evolving technology and learning curve on clinical outcome. Circulation 117: 1964–1972

Right ventricular outflow tract dysfunction can be treated by replacement of the right ventricle-to-pulmonary artery conduit, yet the lifespan of valved conduits are often <10 years, which results in patients having to undergo multiple open heart operations. Lurz et al. have determined that percutaneous pulmonary valve implantation (PPVI) is a safe and effective nonsurgical treatment for pulmonary stenosis and regurgitation that delays the need for surgery in patients with dysfunction of the right ventricular outflow tract.

In all, 155 patients (median age 21.2 years, range 7–71 years) with pulmonary stenosis, pulmonary regurgitation, or both underwent PPVI at one of four hospitals during the period September 2000 to February 2007. After implantation, right ventricular systolic pressure decreased from a mean of 63 ± 18 mmHg to 45 ± 13 mmHg (P <0.001), and right ventricular outflow tract gradient decreased from a mean of 37 ± 20 mmHg to 17 ± 10 mmHg (P <0.001). Freedom from reoperation was 93.2 ± 2%, 86 ± 3%, 84 ± 4%, and 70 ± 13% at 10, 30, 50, and 70 months, respectively. Freedom from transcatheter reintervention was 95 ± 2%, 87 ± 3%, 73 ± 6%, and 73 ± 6% at 10, 30, 50, and 70 months, respectively. Survival at 83 months was 96.9% (median follow-up 28.4 months, range 0–83.7 months).

A marked learning curve could be identified, with patients who underwent PPVI late in the study having a longer freedom from reoperation than the first 50 patients who underwent the procedure. The authors attribute this trend to improvements in patient selection, procedural techniques and device alterations.