Pulmonary valve replacement: extending the indications to the whole spectrum of pulmonary valve disease

Pulmonary valve replacement through a transcatheter technique is currently limited to the small group of patients with a right ventricular outflow tract that does not exceed 22-26 mm in diameter. In this report, we will give an overview of ongoing work to extend the present indication to the vast majority of patients. Second-generation devices and approaches are described, both of which prepare patients to receive the currently available valved stents. The hybrid approach was the first to be applied to humans, but remains highly invasive and justifies research into pure transcatheter strategy. Therefore, it is clear that the transcatheter approach will soon represent the only valuable alternative to on- pump pulmonary valve replacement.