BackgroundTranscatheter pulmonary valve implantation is approved for the treatment of dysfunctional right ventricle to pulmonary artery conduits. However, the literature is limited because of a small patient population, and it does not reflect changing procedural practice patterns over the last decade.Methods and ResultsA comprehensive search of Medline and Scopus databases from inception through August 31, 2016 was conducted using predefined criteria. We included studies reporting transcatheter pulmonary valve implantation in at least 5 patients with a follow‐up duration of 6 months or more. In 19 eligible studies, 1044 patients underwent transcatheter pulmonary valve implantation with a pooled follow‐up of 2271 person‐years. Procedural success rate was 96.2% (95% confidence intervals [CI], 94.6–97.4) with a conduit rupture rate of 4.1% (95% CI, 2.5–6.8) and coronary complication rate of 1.3% (95% CI, 0.7–2.3). Incidence of reintervention was 4.4 per 100 person‐years overall (95% CI, 3.0–5.9) with a marked reduction in studies reporting ≥75% prestenting (2.9 per 100 person‐years [95% CI, 1.5–4.3] versus 6.5/100 person‐years [95% CI, 4.6–8.5]; P<0.01). Pooled endocarditis rate was 1.4 per 100 person‐years (95% CI, 0.9–2.0).ConclusionsOur study provides favorable updated estimates of procedural and follow‐up outcomes after transcatheter pulmonary valve implantation. Widespread adoption of prestenting has improved longer‐term outcomes in these patients.

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Coarctation of the aorta occurs in 0.04% of the population, and accounts for approximately 10% of lesions in adults with congenital heart disease. It can occur as an isolated lesion or as a part of a complex defect, and is most commonly associated with bicuspid aortic valve, ventricular septal defect, and mitral valve abnormalities. Since the first surgical repair in 1944, the available treatment options have expanded greatly. Perhaps one of the most important advances in the management of coarctation of the aorta has been the development of transcatheter therapy for both native and especially recurrent coarctation of the aorta. Late complications, even after apparently successful treatment, are not uncommon. For this reason, lifelong follow-up is vital.

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BACKGROUND Treatment of congenitally corrected transposition of great arteries (cc-TGA) with anatomic repair strategy has been considered superior due to restoration of the morphologic left ventricle in the systemic circulation. However, data on long term outcomes are limited to single center reports and include small sample sizes. AIM To perform a systematic review and meta-analysis for observational studies reporting outcomes on anatomic repair for cc-TGA. METHODS MEDLINE and Scopus databases were queried using predefined criteria for reports published till December 31, 2017. Studies reporting anatomic repair of minimum 5 cc-TGA patients with at least a 2 year follow up were included. Meta-analysis was performed using Comprehensive meta-analysis v3.0 software. RESULTS Eight hundred and ninety-five patients underwent anatomic repair with a pooled follow-up of 5457.2 patient-years (PY). Pooled estimate for operative mortality was 8.3% [95% confidence interval (CI): 6.0%-11.4%]. 0.2% (CI: 0.1%-0.4%) patients required mechanical circulatory support postoperatively and 1.7% (CI: 1.1%-2.4%) developed post-operative atrioventricular block requiring a pacemaker. Patients surviving initial surgery had a transplant free survival of 92.5% (CI: 89.5%-95.4%) per 100 PY and a low rate of need for pacemaker (0.3/100 PY; CI: 0.1-0.4). 84.7% patients (CI: 79.6%-89.9%) were found to be in New York Heart Association (NYHA) functional class I or II after 100 PY follow up. Total re-intervention rate was 5.3 per 100 PY (CI: 3.8-6.8). CONCLUSION Operative mortality with anatomic repair strategy for cc-TGA is high. Despite that, transplant free survival after anatomic repair for cc-TGA patients is highly favorable. Majority of patients maintain NYHA I/II functional class. However, monitoring for burden of re-interventions specific for operation type is very essential.

Our results illustrate a gap in what physicians feel should be done and the care that they feel comfortable providing pregnant women with CHD. As this population continues to grow, training adult CHD cardiologists with specific skills in reproductive health in women with CHD is the first step to closing the care gap that exists in the management of such patients.