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Pulmonary valve repair and replacement - surgical or transcatheter, done properly.

For adults with repaired Tetralogy of Fallot, pulmonary stenosis or a failed RV-PA conduit - a GUCH-trained cardiac surgeon or interventional cardiologist, the full transcatheter conversation up front, and a proper congenital-heart MDT behind the recommendation.

See indicative pricing
A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Indicative pricing

What private pulmonary valve surgery costs in the UK.

Indicative ranges across our partner congenital-heart units.

In short

Transcatheter Melody PVR: £32,000–£46,000, home next day.

Procedure Indicative range
Surgical pulmonary valve replacement (bioprosthetic) £28,000–£42,000
Surgical pulmonary valve repair (valve-sparing) £24,000–£36,000
Transcatheter pulmonary valve - Melody £32,000–£46,000
Transcatheter pulmonary valve - Sapien £34,000–£48,000
Redo surgical PVR (previous sternotomy) £38,000–£56,000
Cardiac MRI (RV volumes, regurgitant fraction) £850–£1,400
Congenital-heart consultation only £300–£500

Prices vary by hospital, by the surgeon, by valve make and size, and by whether tricuspid or arrhythmia work is combined at the same sitting. Transcatheter costs are dominated by the valve itself.

The problem

The right timing, the right route, and a surgeon who does this every week.

Pulmonary valve disease is where general adult cardiology quietly under-delivers - repair-vs-replace decisions delayed, transcatheter options overlooked, and RV volumes allowed to drift past the point of recovery.

  • Do not wait past the imaging thresholds

    RVEDVi over 150 mL/m² or falling CPET is where UK GUCH units act - waiting longer does not reverse the RV dilatation.

  • Ask about transcatheter first

    A Melody or Sapien valve avoids sternotomy in the right anatomy. If nobody has mentioned it, we will.

  • Get the GUCH team involved

    Congenital-heart cases belong in a congenital-heart MDT - not a general adult valve list.

When it helps

When pulmonary valve intervention is the right step.

The situations we see most, plus the one red flag that means the same-day GUCH team rather than a routine appointment.

  • Severe pulmonary regurgitation after Tetralogy repair

    The commonest indication - free regurgitation years after childhood Fallot repair, with RV dilatation on MRI.

  • Symptomatic pulmonary stenosis

    Peak gradient over 64 mmHg on echo, or lower with symptoms - breathlessness, syncope, arrhythmia.

  • Failed RV-PA conduit

    A Rastelli or Ross conduit that has degenerated - regurgitant, stenotic or both.

  • Rising RV volumes on serial MRI

    RVEDVi over 150 mL/m² or RVESVi over 80 mL/m² even without symptoms - the threshold most UK GUCH units act on.

  • Sustained ventricular arrhythmia

    VT or NSVT with a scarred, dilated RV - replacement plus electrophysiology work-up.

  • Falling exercise capacity on CPET

    A drop in peak VO2 below 65 percent predicted, or a steep VE/VCO2 slope, tips watchful waiting into intervention.

  • Endocarditis of the pulmonary valve

    Rare, but a hard indication - vegetations, embolic disease or root abscess need urgent surgical planning.

  • Red flag: syncope or sustained arrhythmia

    Blackouts, sustained VT or new right-heart failure need admission, not an outpatient wait - call your GUCH team the same day.

Procedure options

Surgical, transcatheter or hybrid - anatomy decides.

What each option involves - approach, valve type, and where it sits best in a UK adult congenital-heart pathway.

  • Surgical bioprosthetic PVR

    Median sternotomy, cardiopulmonary bypass, bovine or porcine tissue valve sewn into position. The default for most adult redo-Fallot cases.

  • Surgical mechanical PVR

    Rarely used in the pulmonary position - thrombosis risk is high and lifelong warfarin is needed. Reserved for very specific anatomies.

  • Valve-sparing pulmonary repair

    Where the leaflets are viable, the surgeon reshapes rather than replaces - commissurotomy, cusp augmentation or monocusp reconstruction.

  • Transcatheter - Medtronic Melody

    Bovine jugular vein valve mounted on a stent, delivered via the femoral vein. Best-suited to a stenotic RV-PA conduit or bioprosthetic ring.

  • Transcatheter - Edwards Sapien

    Bovine pericardial valve on a balloon-expandable frame. Handles larger outflow diameters up to 29 mm - extends transcatheter therapy to native outflow tracts.

  • Hybrid pre-stenting

    A covered stent is placed first to create a landing zone in a wide, dysfunctional native RVOT - a second procedure then implants the transcatheter valve.

  • Homograft (cryopreserved)

    A human cadaveric pulmonary valve and conduit - used in complex reoperations and after endocarditis. Availability from UK tissue banks is limited.

  • Ross procedure aftermath

    Patients who had a Ross for aortic disease often need PVR later - the pulmonary autograft that moved into the aortic position leaves a conduit in the RVOT that eventually fails.

Safety and recovery

What to expect afterwards - honestly.

PVR - surgical or transcatheter - is a mature operation with good long-term data. The things worth planning are timing, valve choice, and endocarditis awareness for life.

  • GA, bypass and a cardiac ITU bed

    Surgical PVR needs cardiopulmonary bypass, a cardiac ITU bed and a proper GUCH cardiac anaesthetist. Transcatheter is GA but off-bypass.

  • Bleeding, tamponade and reoperation

    Post-op bleeding needing return to theatre occurs in 2 to 4 percent of surgical cases; tamponade in 1 to 2 percent. The team is set up to recognise it early.

  • Stroke and neurological injury

    Stroke risk is under 1 percent in isolated PVR - lower than left-sided valve surgery - because bypass time is short.

  • Arrhythmia is common early on

    Atrial arrhythmia in 15 to 25 percent early after surgical PVR. Most settle with rate control and cardioversion. Sustained VT is uncommon but taken seriously.

  • Endocarditis risk is not zero

    Prosthetic pulmonary valves - especially bovine jugular vein - carry a small ongoing endocarditis risk. Dental hygiene, an endocarditis card and prophylaxis for high-risk dental work matter.

  • Structural valve degeneration

    All bioprosthetic and transcatheter valves fail eventually. Median freedom from re-intervention is around 10 to 15 years - younger patients need more replacements over a lifetime.

  • Coronary compression at transcatheter implantation

    A rare but serious transcatheter risk - the team tests it with balloon sizing and simultaneous coronary angiography before final deployment.

  • Recovery timeline

    Surgical: 8 to 12 weeks to full activity, driving at 4 to 6 weeks, no lifting over 5 kg for 12 weeks. Transcatheter: office work in 1 week, full exercise in 4 to 6 weeks.

  • Red flags after discharge

    Fever over 38 °C, spreading sternal redness, new breathlessness, blackout or persistent palpitations - same-day team or A&E, not a routine call.

Reading your operation note

Your operation note in four parts. Read the last one first.

Whether your PVR was surgical, transcatheter or hybrid, the note the consultant sends you keeps to the same shape.

A UK consultant cardiologist reviewing a patient's cardiac MRI and operation notes

A quiet reminder

Congenital-heart language is precise and can read coldly - we translate it for you.

If you would like us to talk you through the operation note and the follow-up echo before your review, just ask.

  1. 01 Header

    Diagnosis, approach and valve chosen

    The underlying lesion (repaired Fallot, pulmonary stenosis, failed conduit), whether surgical or transcatheter, and the make, size and serial number of the valve implanted.

  2. 02 Technique

    Bypass time, findings, adjuncts

    Cardiopulmonary bypass and cross-clamp times, any RVOT reconstruction, cryoablation lines for VT and whether tricuspid valve or PFO were addressed at the same sitting.

  3. 03 Findings

    Native valve pathology and RV assessment

    What the surgeon saw - leaflet fibrosis, calcification, aneurysmal RVOT patch, or endocarditic vegetations - plus intraoperative assessment of RV function.

  4. 04 Impression

    Rehab, endocarditis card and echo plan

    Read this first: your rehab timetable, endocarditis prophylaxis card, and when to return for the 6-week, 3-month and yearly echo review.

Recognised by major UK insurers

BupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealix

Pulmonary valve replacement is usually covered when medically indicated. Transcatheter valves are covered under most policies but the valve itself is often a separate line-item.

Frequently asked

Everything we get asked about pulmonary valve surgery.

Quick answers on repair-vs-replace, transcatheter valves, timing, cost and recovery.

  • What is the difference between pulmonary valve repair and replacement?

    Repair keeps your own valve leaflets and reshapes them - a good option where the leaflets are viable, most often in younger congenital-heart cases. Replacement swaps the valve out for a bioprosthetic, mechanical or transcatheter one - the default when leaflets are destroyed, calcified or the outflow tract has been patched wide open.

  • Surgical or transcatheter - how is the decision made?

    It comes down to outflow-tract anatomy on CT. A conduit or bioprosthetic ring within the size range of Melody or Sapien is ideal for transcatheter - no sternotomy, one night in hospital. A wide, patched native RVOT usually needs surgery, sometimes with pre-stenting to convert it to a transcatheter target later.

  • When do you intervene in someone who feels well?

    UK GUCH units use serial cardiac MRI. Thresholds are RVEDVi over 150 mL/m² or RVESVi over 80 mL/m², a drop in peak VO2 below 65 percent predicted on CPET, new sustained arrhythmia, or a QRS over 180 ms on ECG - even without symptoms, because waiting past those points does not reverse RV dilatation.

  • How long does a bioprosthetic pulmonary valve last?

    Median freedom from re-intervention is around 10 to 15 years. Younger patients face more re-interventions over a lifetime, which is one reason the field has moved towards transcatheter valve-in-valve strategies - future replacements can often be done without another sternotomy.

  • How much does private pulmonary valve replacement cost in the UK?

    Roughly £28,000 to £42,000 for surgical bioprosthetic PVR, £32,000 to £48,000 for a transcatheter Melody or Sapien valve, and £38,000 to £56,000 for a redo sternotomy. Cardiac MRI adds around £850 to £1,400.

  • How long is recovery?

    Surgical PVR: 5 to 7 nights in hospital, driving at 4 to 6 weeks, no lifting over 5 kg for 12 weeks, full activity by 3 months. Transcatheter PVR: 1 to 2 nights in hospital, back to office work in a week, and back to full exercise by 4 to 6 weeks.

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