11-Year follow-up of percutaneous pulmonary valve implantation (PPVI) in central South Africa.

BACKGROUND

Excellent mid-term outcomes are well-established for percutaneous pulmonary valve implantation (PPVI) in treating right ventricular outflow tract (RVOT) dysfunction. Despite this success, long-term data assessing PPVI performance are limited, especially within middle- to low-income country contexts.

OBJECTIVE

To report on the patient characteristics and long-term outcomes after PPVI.

METHODS

This retrospective study describes outcomes for 31 PPVI patients treated from 2012 to 2023 at the paediatric cardiology department, Universitas Academic Hospital, Bloemfontein, South Africa.

RESULTS

The predominant underlying diagnosis was tetralogy of Fallot (n = 20, 64.5%). The primary indications for PPVI were pulmonary insufficiency (PI) (n = 15, 48.4%), followed by mixed PI and right ventricular outflow tract (RVOT) stenosis (n = 10, 32.3%), and isolated pulmonary/RVOT stenosis (n = 6, 19.4%). Most implants (n = 22, 71%) were placed within homograft conduits. One early death occurred during the study period, yielding a procedural mortality rate of 3.2%. At 10 years, Kaplan-Meier estimated valve survival was 77%, freedom from stent fracture was 85.3%, and freedom from infective endocarditis (IE) was 81%. The annualised incidence of IE was 1.9%.

CONCLUSIONS

These findings contribute long-term data on PPVI outcomes from a middle-income country setting. The results demonstrate favourable durability and performance, appearing comparable to surgical pulmonary valve replacement benchmarks. However, IE remains a significant long-term complication, underscoring the potential importance of implementing and adhering to stringent prophylactic protocols.