Transcatheter Pulmonary Valve Implantation: A Comprehensive Systematic Review and Meta‐Analyses of Observational Studies

BACKGROUND: Transcatheter pulmonary valve implantation is approved for the treatment of dysfunctional right ventricle to pulmonary artery conduits. However, the literature is limited because of a small patient population, and it does not reflect changing procedural practice patterns over the last decade. METHODS AND RESULTS: A comprehensive search of Medline and Scopus databases from inception through August 31, 2016 was conducted using predefined criteria. We included studies reporting transcatheter pulmonary valve implantation in at least 5 patients with a follow‐up duration of 6 months or more. In 19 eligible studies, 1044 patients underwent transcatheter pulmonary valve implantation with a pooled follow‐up of 2271 person‐years. Procedural success rate was 96.2% (95% confidence intervals [CI], 94.6–97.4) with a conduit rupture rate of 4.1% (95% CI, 2.5–6.8) and coronary complication rate of 1.3% (95% CI, 0.7–2.3). Incidence of reintervention was 4.4 per 100 person‐years overall (95% CI, 3.0–5.9) with a marked reduction in studies reporting ≥75% prestenting (2.9 per 100 person‐years [95% CI, 1.5–4.3] versus 6.5/100 person‐years [95% CI, 4.6–8.5]; P<0.01). Pooled endocarditis rate was 1.4 per 100 person‐years (95% CI, 0.9–2.0). CONCLUSIONS: Our study provides favorable updated estimates of procedural and follow‐up outcomes after transcatheter pulmonary valve implantation. Widespread adoption of prestenting has improved longer‐term outcomes in these patients.