11-Year follow-up of percutaneous pulmonary valve implantation (PPVI) in central South Africa

Dhesan N. Pillay, Stephen C. Brown, Daniël. G. Buys

Abstract

Background: Excellent mid-term outcomes are well- established for percutaneous pulmonary valve implantation (PPVI) in treating right ventricular outflow tract (RVOT) dysfunction. Despite this success, long-term data assessing PPVI performance are limited, especially within middle- to low-income country contexts.
Objective: To report on the patient characteristics and long- term outcomes after PPVI.
Methods: This retrospective study describes outcomes for 31 PPVI patients treated from 2012 to 2023 at the paediatric cardiology department, Universitas Academic Hospital, Bloemfontein, South Africa.
Results: The predominant underlying diagnosis was tetralogy of Fallot (n = 20, 64.5%). The primary indications for PPVI were pulmonary insufficiency (PI) (n = 15, 48.4%), followed by mixed PI and right ventricular outflow tract (RVOT) stenosis (n = 10, 32.3%), and isolated pulmonary/RVOT stenosis (n = 6, 19.4%). Most implants (n = 22, 71%) were placed within homograft conduits. One early death occurred during the study period, yielding a procedural mortality rate of 3.2%. At 10 years, Kaplan-Meier estimated valve survival was 77%, freedom from stent fracture was 85.3%, and freedom from infective endocarditis (IE) was 81%. The annualised incidence of IE was 1.9%
Conclusion: These findings contribute long-term data on PPVI outcomes from a middle-income country setting. The results demonstrate favourable durability and performance, appearing comparable to surgical pulmonary valve replacement benchmarks. However, IE remains a significant long-term complication, underscoring the potential importance of implementing and adhering to stringent prophylactic protocols.