Transcatheter Pulmonary Valve Replacement (TPVR)

Overview

A minimally invasive procedure called transcatheter pulmonary valve replacement (TPVR) is used to replace a malfunctioning pulmonary valve in the heart. Rather of opening their chest during surgery, a surgeon does the treatment through tiny skin incisions in the groin.

The pulmonary valve is important because it regulates the flow of blood from the heart to the lungs. People with congenital heart disease who had surgery as children will frequently experience problems with their pulmonary valve as adults. Replacing a failing pulmonary valve can have a significant impact on lifespan and quality of life, as well as prevent or delay repeat surgeries.

Patients with congenital cardiac disease may require fewer surgical procedures and recover more quickly after TPVR. Both surgical pulmonary valve replacement and TPVR have the risk of valve wear out over time necessitating a second procedure. In the future, if necessary, a repeat TPVR is possible. Patients should weigh the advantages and disadvantages of TPVR vs surgery with their healthcare provider.

Reasons for undergoing the procedure

Pulmonary conditions that the patient have includes the following:

• Pulmonary stenosis: Blood flow from the heart to the lungs is limited by the narrow pulmonary valve. This puts stress on the heart’s right side and could lead to right ventricular failure.
• Pulmonary regurgitation: Blood flow backwards into the heart occurs when the pulmonary valve doesn’t seal completely. The heart and lungs receive less blood as a result, and the right ventricle may fail.

If a patient has congenital heart disease that affects their pulmonary valve, they may benefit from TPVR. Individuals with congenital heart disease who have pulmonary valve surgery as children may experience pulmonary regurgitation or stenosis in their early adult years. Surgeons frequently used homografts, also known as allografts, to replace pulmonary valves. This is a donated human heart’s pulmonary valve. Over time, this homograft may fail, and the most frequent reason why healthcare providers would think about TPVR for a patient is pulmonary homograft failure.

If the patient has a history of any of the following diseases, TPVR can help to improve and correct blood flow through the heart:

• Pulmonary atresia: Blood cannot flow from the right ventricle into the pulmonary artery in a patient who is born without a normal pulmonary valve.
• Regurgitant pulmonary valve: A condition affecting the valves that makes blood flow into the right ventricle backward.
• Tetralogy of Fallot: When the blood leaving and entering the heart mixes due to a combination of four heart defects.
• Truncus arteriosus: When the connection between the pulmonary artery and aorta persists after birth, it results in a single vessel emerging from the heart instead of the usual two.
• Transposition of the great arteries: The condition in which the pulmonary arteries and aorta are connected to the opposing sides of the heart, or reversed.

Individuals who have had aortic stenosis treated with the Ross procedure may also experience pulmonary valve failure and benefit from TPVR.

Risk

The catheter insertion site may cause pain, bruising, or swelling for the patient. Risks could include:

• Arrhythmia or irregular heartbeat
• Blood vessels damage
• Blood clots
• Infections
• Fever
• Pulmonary hypertension
• Unexpected bleeding.

Heart attack, stroke, or even death are uncommon complications of transcatheter pulmonary valve replacement.

Procedure

For some patients with a malfunctioning pulmonary valve, healthcare providers may recommend TPVR over open heart surgery.

Cutting through the chest bone and putting the patient on a heart-lung bypass machine are necessary for surgical pulmonary valve replacement. A new pulmonary valve is implanted in place of the failing one by a surgeon. In certain cases, surgery is too dangerous, and recovery periods are longer.

Opening the chest is not necessary for transcatheter pulmonary valve replacement, which is a minimally invasive procedure. Rather, an interventional cardiologist uses X-ray guidance to make tiny incisions in the patient’s groin to advance a replacement valve from their leg vein to their heart. A surgeon places the new valve in place of the old one after it is in the proper position. This condition reestablishes the circulation of blood from the heart to the lungs, reduces the workload on the heart, and enhances the oxygen supply to the body. After this treatment, patients typically return home the next day.

Before the procedure

The healthcare provider evaluates the patient’s health and cardiac function through a physical examination and exercise stress test to decide if TPVR is the best course of action. The patient might also have diagnostic procedures done, such as:

• Angiogram
• Computed tomography (CT) scan of the herat
• Magnetic resonance imaging of the heart
• Echocardiogram
• Electrocardiogram (ECG)

The healthcare provider may decide to monitor the heart over time (watchful waiting) or recommend TPVR based on the results. The patient and the healthcare provider will discuss the best course of action for their condition.

Before the procedure, the patient will receive specific instructions from their healthcare provider, outlining details such as the designated time for eating and drinking, recommended attire for the day of the procedure, and guidance on which medications to either discontinue or adjust.

Patient should inform their healthcare provider of any allergies they may have and provide details about supplements or medications they are taking, including blood thinners (anticoagulants) or nonsteroidal anti-inflammatory drugs (NSAIDs). This information ensures that the healthcare team can make well-informed decisions tailored to the individual’s health and well-being during the upcoming medical intervention.

During the procedure

The cardiologist who will perform transcatheter pulmonary valve replacement will do the following:

• The patient will be given anesthesia before to the surgery to ensure they are pain-free.
• Makes an incision in their neck’s jugular vein or femoral vein in their groin to insert a thin, hollow tube called a catheter.
• Guides the valve along a wire via the vein to its proper location inside the existing valve using imaging methods including fluoroscopy and angiography. The healthcare provider compresses the valve with a balloon, allowing the surgeon to smoothly advance it through your vein. The valve instantly starts to help regulate blood flow when the balloon expands it.
• Evaluates valve function using transesophageal echocardiography or intracardiac echocardiogram.
• To determine how much less strain is exerted on the heart, measures the pressures within the heart both before and after replacing the valve.
• Then the catheters will be removed.

The procedure will takes around two to three hours to finish.

After the procedure

The patient will be observed overnight following the procedure and discharged the next morning. To help in the patient’s recovery, the healthcare provider provides them with detailed care instructions.

Most patients are able to resume their regular activities within seven days. Ask for any further questions or concerns from the healthcare professional.

Outcome

Compared to open-heart surgery, transcatheter pulmonary valve replacement has a number of benefits, including as a quicker recovery period, a lower risk of infection, shorter hospital stays, and fewer incisions and scars. For those having this cardiac treatment, these advantages add to a more efficient and possibly less invasive experience.

The heart health and general health are two of the several factors that affect how long the valve lasts. To repair their pulmonary valve, some patients might need to have another surgery.

Infections can result from dental procedures that releases germs into the blood. Inform the dentist ahead of time of the pulmonary valve replacement. Before their dental appointment, the patient might need to take medication.

To have an excellent result, follow to the instructions given by the healthcare provider and show up on time for the follow up appointments. If the patient has any unexplained discomfort, fever, or other symptoms following TPVR surgery, get in touch with the healthcare provider.