Transcatheter versus surgical pulmonary valve replacement in native RVOT: A 3-year propensity score-matched study.

BACKGROUND: Surgical pulmonary valve replacement (SPVR) is the standard therapy for native or patched right ventricular outflow tract (nRVOT) dysfunction. Transcatheter pulmonary valve replacement (TPVR) has emerged as a less invasive alternative, but comparative data are lacking. OBJECTIVES: To compare clinical outcomes and valve performance between TPVR and SPVR in patients with nRVOT dysfunction. METHODS: Patients with nRVOT dysfunction undergoing TPVR or SPVR were retrospectively identified. TPVR cases were propensity score-matched 1:2 to SPVR. The primary outcome was freedom from all-cause mortality, prosthetic valve endocarditis, or valve-related reintervention. RESULTS: Among 176 patients, 123 (41 TPVR, 82 SPVR) were matched. At 3 years, freedom from the primary outcome was 95.2% for TPVR and 91.5% for SPVR (HR 0.68; 95% CI 0.14-3.29; p = 0.63). TPVR had fewer major in-hospital complications (4.9% vs 18.3%; p = 0.04) and shorter ICU and hospital stays (0.3 ± 0.8 vs 4.8 ± 6.9 days, and 3.1 ± 3.0 vs 12.9 ± 14.6 days; both p < 0.001). Mean gradients were consistently lower with TPVR post-procedure (8.0 vs 9.9 mmHg; p = 0.02), at 1 year (7.9 vs 10.6 mmHg; p = 0.02), and at 3 years (8.4 vs 11.0 mmHg; p = 0.03). Pulmonary regurgitation remained comparable, with most patients having none or mild regurgitation at 3 years (90.0% vs 94.5%; p = 0.22). CONCLUSIONS: In the first propensity score-matched comparison of TPVR and SPVR in nRVOT dysfunction, TPVR demonstrated comparable 3-year clinical outcomes, fewer major in-hospital complications, shorter hospital stay, and more favorable valve hemodynamic performance. These findings support TPVR as an effective, less invasive alternative, although longer-term outcomes warrant further study.