Position Statement by the Saudi Heart Failure Working Group of the Saudi Heart Association on the Management of Advanced Heart Failure in Saudi Arabia.

OBJECTIVES

To provide an expert consensus on the appropriate use of transcatheter pulmonary valve replacement (TPVR) in managing chronic pulmonary regurgitation (PR), particularly in patients with congenital heart defects such as Tetralogy of Fallot (TOF). The consensus aims to address current practices, patient selection criteria, procedural planning, and device-specific considerations to guide clinicians in optimizing outcomes.

METHODS

A multidisciplinary panel reviewed existing literature, clinical guidelines, and real-world practices. Key domains covered include epidemiology, anatomical and hemodynamic evaluation, pre- and post-procedural imaging, device characteristics, and patient selection. Imaging modalities such as echocardiography, cardiac magnetic resonance (CMR), and computed tomography (CT) were critically appraised for their role in procedural planning. Recommendations were structured to reflect best practices across varied healthcare settings.

RESULTS

TPVR is increasingly adopted as a less invasive alternative to surgical pulmonary valve replacement. Devices such as Melody, SAPIEN, Harmony, and Venus P-valve are used based on RVOT anatomy and size. Pre-procedural imaging and multidisciplinary assessment are critical for safe deployment and optimal valve positioning. TPVR demonstrated favourable outcomes in terms of RV remodelling, PR and PS reduction, functional improvement, and reduced hospital stay compared to surgical approaches. Complications such as tricuspid valve injury, stent fracture, and infective endocarditis remain concerns.

CONCLUSIONS

TPVR offers a safe and effective treatment for selected patients with PR or PS following congenital heart disease repair. A standardized, imaging-guided approach with multidisciplinary oversight is essential. Further research is needed to assess long-term valve durability and to refine strategies for high-risk and paediatric populations.