If you had a pulmonary valve replacement in childhood and develop narrowing or leaking in the new valve, you may need another replacement procedure as an adult. With transcatheter pulmonary valve replacement (TPVR), we can replace your pulmonary valve without opening your chest for surgery.
What is Transcatheter Pulmonary Valve Replacement (TPVR)?
Transcatheter pulmonary valve replacement, also known as TPVR, is a minimally invasive structural heart disease treatment to replace a failing prosthetic pulmonary valve. The pulmonary valve controls blood flow from the heart's lower right heart chamber (ventricle) to the lungs. Severe problems with the pulmonary valve can slow blood flow or lead to right-sided heart failure.
In TPVR, an interventional cardiologist replaces a damaged prosthetic pulmonary valve with a new one. They use a thin, flexible tube (catheter) to implant a new pulmonary valve without opening the chest.
Who is a Good Candidate for Transcatheter Pulmonary Valve Replacement?
TPVR is typically a treatment for adults with congenital heart diseases who had a procedure to replace their pulmonary valve in childhood. Some of these patients had a Ross procedure, in which a surgeon replaced their aortic valve with their pulmonary valve. Others received a prosthetic valve or conduit (tube) during a prior operation.
Replacement heart valves may last 15 years or longer, but they don't always last a lifetime. Over time, a prosthetic or donor pulmonary valve may develop problems such as:
- Pulmonary valve regurgitation: The pulmonary valve doesn't close properly, causing leaking. Severe regurgitation may lead to reduced blood flow and right-sided heart failure.
- Pulmonary valve stenosis: The pulmonary valve narrows, restricting blood flow from the right ventricle to the lungs. This strains the right ventricle and may damage it over time.
What Conditions Does TPVR Treat?
People who are candidates for TPVR typically have a history of congenital heart diseases that affect the pulmonary valve, including:
- Pulmonary atresia: People are born with no pulmonary valve.
- Tetralogy of Fallot: This combination of four congenital heart defects causes problems with blood flow.
- Truncus arteriosus: The pulmonary artery, which sends blood from the heart to the lungs, and the aorta, which sends blood out to the body, are connected. The result is that babies are born with only one blood vessel coming out of the heart instead of two.
- Transposition of the great arteries: The body's two main arteries, the pulmonary artery and the aorta, are in switched positions.
In the past, the only option to replace the pulmonary valve involved opening the chest and breastbone with a long incision. This approach requires a long surgical time and comes with a much longer, more painful recovery.
TPVR is a minimally invasive approach, which offers a shorter recovery and a lower risk of complications. It is often a better alternative for people who have higher risks of surgery complications, such as older patients and those with underlying health conditions.
Cardiologists at Penn Medicine offer several options to treat a failing pulmonary valve, including TPVR, pulmonary valve repair and replacement and valvuloplasty. Your cardiologist can recommend the best treatment option for you based on your needs and risk factors.
What to Expect During a TPVR Procedure
TPVR is an inpatient procedure that usually takes two to three hours. You receive anesthesia to make sure you're calm and comfortable.
When it's time for the procedure, the team connects you to an electrocardiogram machine that monitors your heart's electrical activity. You also are connected to machines that record your heart rate, breathing, oxygen levels and blood pressure.
The TPVR team includes an interventional cardiologist, an interventional echocardiographer and an anesthesia specialist. During TPVR, your interventional cardiologist:
- Makes a tiny incision in your groin and inserts a flexible, hollow tube (catheter) into a blood vessel
- Uses imaging guidance to direct the catheter to your pulmonary valve
- Threads a compressed heart valve through the catheter
- Positions the new valve inside the damaged prosthetic valve
- Expands the new pulmonary valve to secure it in place
Recovery After TPVR
You can expect to spend one to three days in the hospital after a TPVR procedure. Your care team closely monitors your recovery in the hospital and gives you specific instructions to care for yourself when you return. You can usually resume your day-to-day activities in about a week.
Your cardiologist may recommend cardiac rehabilitation during TPVR recovery. Our cardiac rehab program offers you personalized guidance and support to increase your heart health. Our specialists offer heart health education, exercise guidance and nutrition counseling. Find out more about cardiac rehab.
Benefits of Transcatheter Pulmonary Valve Replacement
Surgically implanted heart valves don't last forever. Because of this, most people with congenital heart disease will need multiple procedures to treat a failing pulmonary valve throughout their lifetime. A TPVR procedure replaces failing pulmonary valves without the risks of open-heart surgery. It expands treatment options, especially for older patients or those with underlying health conditions who have high risks associated with open-heart surgery.
As a minimally invasive procedure, TPVR offers a smaller incision, faster recovery and less pain than open-heart surgical options. People spend less time in the hospital recovering and have a lower risk of infection and other complications.
Transcatheter Pulmonary Valve Replacement: The Penn Medicine Advantage
Penn interventional cardiologists are experts in minimally invasive pulmonary valve replacement. We have a rich history of innovation, continually providing the most advanced treatments — often before they're widely available. When you choose us for treatment, you benefit from:
- Leading physicians: Penn's interventional cardiology program has offered catheter-based heart valve replacements longer than any other medical system in the Philadelphia region. This longstanding experience positions our physicians among the most experienced in the region.
- Clinical trials: We actively research new treatments and best practices. Our research involvement gives you direct access to innovative new therapies for pulmonary valve replacement and repair.
- State-of-the-art technology: We perform transcatheter valve replacements in our state-of-the-art catheterization laboratory (cath lab). The cath lab houses the most advanced technology in a comfortable environment. Advanced imaging technology and specialized interventional echocardiographers enable us to perform heart procedures with outstanding precision and visualization.
Make an Appointment
Please call 800-789-7366 or request a callback.