e-ISSN : 2149-8156
Turkish Journal of Thoracic and Cardiovascular Surgery     
Early-term results of percutaneous pulmonary valve implantation (valve-in-valve) in dysfunctional bioprosthetic valves in pulmonary position
Ensar Duras1, Erman Çilsal1, Selman Gökalp1, Sezen Ugan Atik1, Murat Şahin1, Bekir Yükcü1, Alper Güzeltaş1
1Department of Pediatric Cardiology, University of Health Sciences, İstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Türkiye
DOI : 10.5606/tgkdc.dergisi.2025.26622
Background: This study aimed to assess the outcomes of valve-in-valve implantation within previously placed bioprosthetic valves.

Methods: This single-center retrospective study included patients who underwent percutaneous valve-in-valve procedures between July 2014 and September 2023. These patients had previously received pulmonary bioprosthetic valves via surgical or transcatheter methods.

Results: The study included 20 patients (13 males, 7 females; mean age: 20.4±7.1 years; range, 10.8 to 35.8 years). Preprocedural assessment revealed stenotic dysfunction in 12 patients, regurgitant dysfunction in two patients, and a combination of both in six patients. Following implantation, there was a notable improvement in invasive measurements; systolic right ventricular pressure decreased from 64.0±24.5 mmHg to 31.3±6.7 mmHg (p<0.001), right ventricular outflow tract gradient from 44.0±23.2 mmHg to 7.6±5.8 mmHg (p<0.001), and echocardiographic pulmonary regurgitation grade from 2.1±1.2 to 0.2±0.4 (p<0.001). The median time between initial bioprosthetic pulmonary valve placement and valve-in-valve procedure was 8.2 years (IQR, 6.2 to 9.9 years). The median follow-up duration was 24.8 months (IQR, 8.3 to 40.2 months). Only one patient required a repeat PPVI procedure 10 years after the valve-in-valve procedure, while no other patients required reintervention during the follow-up period.

Conclusion: Valve-in-valve implantation within previously placed bioprosthetic valves is a feasible and safe approach, offering symptom relief and eliminating the need for further surgical interventions.

Keywords : Bioprosthetic valve, interventional cardiology, percutaneous pulmonary valve implantation, tetralogy of Fallot, valve-in-valve
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