Transcatheter Pulmonary Valve Replacement (TPVR)

What is transcatheter pulmonary valve replacement?

Transcatheter pulmonary valve replacement (TPVR) is a minimally invasive surgery to replace a failing pulmonary valve in your heart. A surgeon performs the procedure through tiny skin incisions in your groin, rather than opening your chest with surgery. The pulmonary valve is important because it controls the flow of blood from your heart to your lungs. People born with congenital heart disease who had surgery in childhood will often develop issues with their pulmonary valve as adults. Replacing a failing pulmonary valve can have a huge impact on lifespan and quality of life, and may delay or avoid repeat surgeries.

What does TPVR do?

Healthcare providers may offer TPVR instead of open-heart surgery for some people with a failing pulmonary valve.

Surgical replacement of the pulmonary valve requires cutting through the chest bone and placing the person on a heart-lung bypass machine. A surgeon removes the failing pulmonary valve and replaces it with a new one. Recovery times are longer, and in some people, surgery is too risky.

Transcatheter pulmonary valve replacement is minimally invasive and doesn't require opening your chest. Instead, an interventional cardiologist goes through tiny incisions in your groin to advance the new valve from your leg vein to your heart under X-ray guidance. Once the valve is in the correct position, a surgeon implants it in place of the old one. This restores blood flow from your heart to your lungs, places less strain on your heart, and delivers more oxygen to your body. People who have this procedure often go home the next day.

Overall, people with congenital heart disease who undergo TPVR may have faster recovery times and need fewer surgical procedures. In both TPVR and surgical pulmonary valve replacement, the valve can wear out over time and may require a repeat operation. It’s possible to have a repeat TPVR in the future if needed. Close monitoring is important, and you should discuss the pros and cons of TPVR versus surgery with your healthcare provider.

What happens if my pulmonary valve does not work properly?

Pulmonary conditions you may have include:

• Pulmonary stenosis: Your pulmonary valve is narrow, limiting blood flow from your heart to your lungs. This places strain on the right side of your heart, and may cause failure of the right ventricle.
• Pulmonary regurgitation: Your pulmonary valve doesn’t close properly, causing blood flow to leak backwards into your heart. This also reduces blood flow to your heart and lungs, and may cause failure of the right ventricle.

Both conditions can cause symptoms of shortness of breath (dyspnea), swelling in your abdomen and legs (edema), chest pain or palpitations. The symptoms are a result of heart failure or arrhythmias than can improve after TPVR.

Who can benefit from transcatheter pulmonary valve replacement?

You might benefit from TPVR if you were born with congenital heart disease that affects your pulmonary valve. People with congenital heart disease who had surgical repair or placement of the pulmonary valve in childhood may develop pulmonary stenosis or regurgitation in early adulthood. Often, surgeons replaced the pulmonary valve with a homograft (also called allograft). This is a pulmonary valve from a donated human heart. This homograft can fail over time, and pulmonary homograft failure is the most common reason providers may consider a person for TPVR.

What conditions does transcatheter pulmonary valve replacement treat?

TPVR can improve and correct blood flow through your heart if you have a history of conditions such as:

• Pulmonary atresia: When you’re born without a normal pulmonary valve, so blood cannot flow from the right ventricle into the pulmonary artery.
• Regurgitant pulmonary valve: A valve disease that causes your blood to flow backward into the right ventricle.
• Tetralogy of Fallot: When a combination of four heart defects causes the blood entering and leaving your heart to mix.
• Truncus arteriosus: When the aorta and pulmonary artery remain connected after birth, so one vessel instead of two comes out of your heart.
• Transposition of the great arteries: When the aorta and pulmonary arteries are reversed — meaning they’re attached to opposite sides of the heart.

People who’ve undergone the Ross procedure for aortic stenosis may also develop pulmonary valve failure and may benefit from TPVR.

How common is transcatheter pulmonary valve replacement?

Transcatheter heart valve replacement procedures, which include TPVR, are common. In 2020, providers performed more than 91,000 in the U.S.

In 2000, a French cardiologist performed the first successful TPVR treatment in a person. Since then, healthcare providers have performed thousands of these procedures. Currently, there are three types of valves approved by the U.S. Food and Drug Administration (FDA).

Who performs transcatheter pulmonary valve replacement?

An interventional cardiologist specializing in congenital cardiac disease performs transcatheter pulmonary valve replacement.

Where is transcatheter pulmonary valve replacement performed?

Your provider performs TPVR in a pediatric or adult congenital cardiac catheterization lab. This type of lab is usually in a hospital or medical center.

What happens before transcatheter pulmonary valve replacement?

To determine if TPVR is right for you, your healthcare provider gives you a physical examination and exercise stress test, which assess your health and heart function. You may also undergo diagnostic tests, including:

• Angiogram.
• Cardiac CT scan.
• Heart MRI.
• Echocardiogram.
• Electrocardiogram (EKG).

Based on the results, your provider may recommend TPVR or choose to monitor your heart over time (watchful waiting). Your provider will talk to you about which option works best for your condition.

How should I prepare for transcatheter pulmonary valve replacement?

Your healthcare provider gives you instructions before the procedure, including:

• When you can eat and drink.
• What to wear on the day of your procedure.
• What medications to stop taking or adjust.

Before your procedure, tell your healthcare provider about:

• Any allergies you have.
• Supplements or medications you take, including blood thinners (anticoagulants) or nonsteroidal anti-inflammatory drugs (NSAIDs).

What happens during transcatheter pulmonary valve replacement?

Before the procedure begins, you receive anesthesia so you don't feel any pain.

During transcatheter pulmonary valve replacement, your cardiologist:

• Inserts a thin, hollow tube (catheter) through an incision in your femoral vein (in your groin) or jugular vein in your neck.
• Uses imaging tools such as fluoroscopy and angiogram to guide the valve over a wire through the vein to its correct position inside the existing valve. A provider crimps the valve on a balloon so that your surgeon can easily advance it through your veins. The balloon expands the valve, which immediately begins to help control blood flow.
• Uses intracardiac echocardiography or transesophageal echocardiography to assess valve function.
• Measures pressures in your heart before and after replacing the valve to assess the decrease in strain placed on your heart.
• Removes the catheters.

How long does TPVR take?

Most transcatheter pulmonary valve replacements take two to three hours.

What happens after transcatheter pulmonary valve replacement?

After the procedure, you stay overnight for observation and leave the following morning. Your healthcare provider gives you specific care instructions to help you recover. In most cases, you can return to your routine in seven days. Ask your provider if you have any additional questions or concerns.

What are the advantages of transcatheter pulmonary valve replacement?

The advantages of transcatheter pulmonary valve replacement compared with open heart surgery include:

• Less recovery time.
• Lower risk of infection.
• Shorter hospital stay.
• Smaller incisions and scars.

What are the risks or complications of TPVR?

You may experience pain, bruising or swelling at the catheter insertion site. Risks may involve:

• Blood clot.
• Damage to blood vessels.
• Fever.
• High blood pressure in the lungs (pulmonary hypertension).
• Infection (endocarditis).
• Irregular heartbeat (arrhythmia).
• Unexpected bleeding.

Rarely, transcatheter pulmonary valve replacement may lead to heart attack, stroke or death.

How long will my new pulmonary valve last?

The length of time that your valve lasts depends on many factors, including your heart and overall health. Some people may require another procedure to fix their pulmonary valve.

When should I see my healthcare provider?

Follow your healthcare provider's instructions and attend your medical appointments to ensure the best possible outcome. Contact your provider if you have unexplained fever, pain or other symptoms after TPVR surgery.

May I go through airport security if I had TPVR?

Yes. X-rays and airport security are safe if you’ve had transcatheter pulmonary valve replacement. However, you should talk to your healthcare provider before having an MRI.

Do I need to take precautions before dental procedures if I had transcatheter pulmonary valve replacement?

Yes. Dental work can release bacteria into your blood and cause infection. Tell your dental provider about your pulmonary valve transplant in advance. You may need to take medicine before your dental appointment.

A note from Cleveland Clinic

If you were born with heart disease, you might have had multiple surgeries to fix a pulmonary heart valve. Transcatheter pulmonary valve replacement provides a minimally invasive option for some people, with fewer incisions and faster recovery. It may also help you delay or decrease the number of surgeries you need to maintain heart health over your lifetime.