Transcatheter pulmonary valve replacement: what we know, what we still want to know

Transcatheter pulmonary valve replacement (TPVR) has transformed the management of patients with congenital heart disease (CHD) with dysfunctional pulmonary outflow tracts. Technological advancements have expanded the number of patients eligible for this minimally invasive alternative to surgical valve replacement. With the introduction of larger self-expanding valves and adaptive prestenting systems, TPVR has become accessible to patients with complex anatomies, including those with native right ventricular outflow tract (RVOT) disease.

Recent studies have demonstrated the excellent clinical outcomes of TPVR thus far, while also acknowledging the occurrence of rare complications. Crucial questions guiding the future of TPVR management include: timing to refer for TPVR, how to optimize valve durability, enhance preprocedural screening with advanced imaging and electrophysiology studies, and improve hemodynamic monitoring.

These advancements underscore TPVR's adaptability and efficacy, offering new solutions for complex cases and improving outcomes. Future research should focus on optimizing patient selection and intervention timing, as well as addressing long-term durability and complications.