Clinical outcomes of transcatheter versus surgical pulmonary valve replacement: a meta-analysis

Transcatheter pulmonary valve replacement (TPVR) has currently been a well-established alternative operation method to surgical pulmonary valve replacement (SPVR) in patients with pulmonary valve dysfunction in the form of stenosis and/or regurgitation. We conducted a meta-analysis to evaluate the main clinical outcomes after TPVR and SPVR.

We systematically searched the references of relevant literatures from PubMed and the Cochrane Library published between January 2000 and December 2018 and followed The Preferred Reporting Items for Systematic reviews and Meta-analysis (PRISMA) for this study.

Eleven studies with 4,364 patients were included in the study. Compared with SPVR, TPVR results in a significant decreased in-hospital mortality [odds ratio (OR): 0.18; 95% confidence interval (CI): 0.03-0.98] and mortality at the longest reported follow-up time point (OR: 0.43; 95% CI: 0.22-0.87), though 30-day mortality (OR: 0.38; 95% CI: 0.11-1.33) has no significant difference between groups. Days of hospital stay [(mean difference (MD): -4.38; 95% CI: -6.24--2.53] is shorter with TPVR than SPVR. Besides, rates of 30-day readmission (OR: 0.67; 95% CI: 0.50-0.91) and recurrent pulmonary regurgitation (OR: 0.17; 95% CI: 0.07-0.42) are lower with TPVR, whereas postprocedural infective endocarditis (IE) (OR: 4.56; 95% CI: 2.03-10.26) are higher with TPVR. SPVR carries a decreased risk of re-operation (OR: 2.19; 95% CI: 0.62-7.76) though without statistically significance.

In conclusion, TPVR is associated with a significantly decreased mortality, a shorter length of hospital-stay, a lower rate of 30-day readmission and recurrent pulmonary regurgitation as compared to SPVR throughout the follow-up duration, whereas SPVR results in a significantly lower rate of postprocedural IE than TPVR. In addition, SPVR carries a decreased risk of re-operation with statistically insignificance.