Surgical pulmonary valve redo versus transcatheter pulmonary valve replacement for Tetralogy of Fallot patients.

OBJECTIVES

To perform a systematic review to compare the efficacy and safety of transcatheter pulmonary valve replacement (TPVR) and surgical pulmonary valve replacement (SPVR) in managing pulmonary valve dysfunction in Tetralogy of Fallot (TOF) patients.

METHODS

This review investigates through three different databases for randomized control trials or observational studies evaluating TOF patients who underwent TPVR or SPVR until November 2024. The outcomes of interest were hemodynamic improvement, reduction in pulmonary regurgitation or stenosis, complications, quality of life, and long-term outcomes.

RESULTS

Four retrospective studies (1919 procedures) were analyzed. TPVR was non-inferior to SPVR, with a comparable safety profile. The durability of bioprosthetic valves was similar between TPVR and SPVR (HR: 0.97, 95% CI: 0.55-1.73; p = 0.93) and was influenced by patients' age at PVR (HR: 0.78 per 10 years from <1 year; 95% CI: 0.63-0.96; p = 0.02) and true inner valve diameter    .

CONCLUSIONS

TPVR is a safe and less-invasive alternative to SPVR with comparable efficacy in reducing pulmonary regurgitation. Complication rates are similar and valve durability is primarily age- and valve size-dependent. Although further research on long term outcomes is needed, TPVR may be integrated into routine practices, offering a viable alternative for high-risk TOF patients.

REGISTRATION: This systematic review was registered on the international prospective register of systematic reviews (PROSPERO; #CRD42024615871).