Percutaneous Pulmonary Valve Perforation in Pulmonary Atresia With Intact Ventricular Septum: Multicenter Comparison of Radiofrequency Versus Chronic Total Occlusion Wires.

Background: Percutaneous radiofrequency (RF) wire pulmonary valve perforation (PVP) in pulmonary atresia/intact ventricular septum (PA/IVS) is a high-risk procedure. This study compared procedural efficacy and complications between RF and chronic total occlusion (CTO) wire PVP. Methods: This multicenter study included patients with PA/IVS who had PVP attempted at 13 centers. Outcomes of interest were efficacy and complications. Univariable logistic regression models were used to estimate odds ratios and risk differences. Results: PVP was attempted in 206 patients; median age 3.0 days (1.0-6.0) and weight 3.1 kg (2.7-3.5). The RF PVP was attempted first in 165 (80.0%) patients, CTO in 27 (13.1%), and stiff end of the coronary wire in 14 (6.8%). The procedural success rate of 94% was similar between wire types. CTO group utilized smaller initial valvuloplasty balloons (2.25 mm [2-3] vs 4 mm [3-6]) and >2 balloons in 71% of cases (vs 18% in RF). Overall and major procedural complications occurred in 26.5% versus 12.5% (odds ratios [OR], 2.5 [0.8-11.1]; Conclusions: PVP remains an effective treatment strategy in PA/IVS. Complication rate differences between CTO and RF wires may be clinically relevant. Further studies with larger cohorts are warranted to confirm findings and guide optimal intervention strategies.