Single-Center Experience with Venus-P Self-expanding Pulmonary Valve: Insights on Valve Sizing and Procedural Techniques

We share a single-center experience of transcatheter pulmonary valve replacement (PVR) with the Venus-P valve, discussing procedural insights, considerations for valve sizing in relation to valve expansion and geometry, and associated outcomes. Retrospective review of 42 consecutive cases from January 2017 to March 2024. The median age and weight of the cohort were 39.6 (27.3, 58.6) years and 69.8 (59.8, 85.3) kg and the Venus-P valve was successfully implanted in 98%. Severe adverse events included valve migration requiring surgical explant and PVR (n = 1), sustained ventricular arrhythmia (n = 1), and endocarditis (n = 1). At mean follow-up of 20.3 ± 19.6 months, there was no deterioration in valve performance and statistically significant improvement in NYHA class, right ventricular volumes, biventricular stroke volume, and LV ejection fraction. Cinefluoroscopic measurements of the deployed valves showed highest expansion and lowest eccentricity at valve coaptation level and greater frame deformation at the inflow compared to outflow flare. Supra-annular (n = 9) implant showed a higher expansion of the straight valve section compared to transannular (n = 32) deployment, related to lesser degree of valve oversizing and tissue characteristics at implant site. Transcatheter PVR with the Venus-P valve can be safely performed in a broad range of anatomies with clinical benefit at medium-term follow-up. Valve sizing focused on adequate deformation of inflow and outflow flares at implant location with minimal constrain at the valve portion and supra-annular positioning, may result in a higher degree of valve expansion and circularity. Ongoing follow-up of this cohort will provide important insights into valve longevity and long-term outcomes.