A New Simplified Technique for Making Tricuspid Expanded Polytetrafluoroethylene Valved Conduit for Right Ventricular Outflow Reconstruction
Pusan National University, Tsau-liang-hai, Busan, South KoreaThe Annals of thoracic surgery (Impact Factor: 3.85). 05/2013; 95(5):e131-3. DOI: 10.1016/j.athoracsur.2012.12.047
Several methods of making expanded polytetrafluoroethylene valved conduit have been reported, but these techniques are complicated and less reproducible. We have developed a new simplified technique for making a tricuspid expanded polytetrafluoroethylene valved conduit for right ventricular outflow tract reconstruction and have been using this conduit for approximately 3 years with excellent results. Our technique is straightforward and reproducible, and the cusps in the conduit are durable due to the use of a specialized suturing technique.
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ABSTRACT: There is no optimal substitute for right ventricular outflow tract (RVOT) reconstruction in congenital heart defects. Expanded polytetrafluoroethylene (ePTFE) valved conduits and patches may be a good alternative to homografts and bovine jugular veins. We have developed a fan-shaped ePTFE valve and an ePTFE valved conduit and patch with bulging sinuses with the aim of enhancing the long-term valve function. Bulging sinuses were constructed on ePTFE conduits and patches as described previously (J Thorac Cardiovasc Surg. 2007;134:327-32). Between February 2001 and January 2011, 794 patients (aged 14 days to 56.8 years old; median, 2.0 years old) had ePTFE valves implanted for RVOT reconstruction at 52 Japanese institutes. Conduits with a fan-shaped ePTFE valve were implanted in 325 patients and a patch with a fan-shaped ePTFE valve was implanted in 469 patients. Valve function was assessed by a series of echocardiograms postoperatively. The mean follow-up was 3.6 years (1.1 months to 10.0 years). Freedom from reoperation at 10 years was 95.4% in patients with conduits and 92.3% in those with patches. Pulmonary insufficiency was mild or nonexistent in 95.0% of patients with conduits and 79.6% of patients with patches. The pressure gradient between the right ventricle and the pulmonary artery was 14.0 ± 13.2 mm Hg in patients with conduits and 11.6 ± 11.6 mm Hg in patients with patches. Fan-shaped ePTFE valved conduits and patches with bulging sinuses have a high freedom from reoperation and prevent pulmonary insufficiency. They represent a promising material for RVOT reconstruction.The Journal of thoracic and cardiovascular surgery 09/2011; 142(5):1122-9. DOI:10.1016/j.jtcvs.2011.08.018 · 4.17 Impact Factor
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ABSTRACT: To maintain pulmonary valvar function subsequent to repair of tetralogy of Fallot, we have inserted a homograft monocusp when a transjunctional patch was required. In this study, we have evaluated the mid- to long-term outcomes, aiming to determine the durability of the homograft. Among 218 repairs performed for tetralogy of Fallot between July, 1996, and June, 2005, we inserted homograft monocusps in 54 patients, 4 of whom had associated absent pulmonary valve syndrome, 3 had pulmonary valvar atresia, and 1 had an atrioventricular septal defect with common atrioventricular junction. The median body weight at surgery was 7.8 kilograms, with a range from 3.9 to 42 kilograms. The function of the monocusp valve was assessed by regular echocardiography, using the Kaplan-Meier method and the Cox regression model for statistical analyses. There were 2 early deaths (3.7%), associated with respiratory infection. No late deaths were observed during the follow-up, which ranged from 0.3 to 120 months, with a median of 64.3 months. Freedom from valvar dysfunction was 67.2 +/- 6.7% at 1 year, 37.1 +/- 7.3% at 3 years, 23.8 +/- 6.7% at 5 years, and 21.2 +/- 6.4% at 7 years. We needed to replace the valve in 1 patient during follow-up. We found that ABO blood group incompatibility, stenosis of the pulmonary arteries, and associated absent pulmonary valve syndrome all adversely affected the function of the monocusp. Our experiences show that insertion of a homograft monocusp can prevent pulmonary regurgitation in the early period after repair of tetralogy of Fallot, but the effects are limited in duration as degeneration progressed. We still need to determine whether this finding can improve the longer-term function of the right ventricle.Cardiology in the Young 05/2008; 18(2):141-6. DOI:10.1017/S1047951108001923 · 0.84 Impact Factor
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ABSTRACT: The objective of this study was to investigate the results of handmade polytetrafluoroethylene trileaflet conduits implanted in the pulmonary position since 1997. One hundred thirty-nine patients underwent pulmonary reconstruction with a polytetrafluoroethylene conduit. Conduit function was investigated by means of review of serial echocardiographic studies. Mean age and body weight were 12.7 +/- 12.0 years and 30.9 +/- 20.6 kg. Mean size of the conduit was 21.0 +/- 3.8 mm (12-28 mm). The z score of the conduit was +0.5 +/- 0.8 for patients older than 15 years (n = 43), +1.2 +/- 0.7 for patients 5 to 15 years old (n = 48), and +2.4 +/- 0.5 for patients younger than 5 years (n = 48). Conduits were used for the Ross procedure in 21 patients and for repair of complex congenital heart disease in 118 patients. There were 3 (2.2%) in-hospital deaths and 1 late death. Four patients required conduit explantation because of pulmonary artery distortion at a distal anastomotic site (interval, 1.2 years), infection of the polytetrafluoroethylene valve (interval, 1.6 years), midportion angulation of the conduit (interval, 4.9 years), and conduit compression by the ascending aorta (interval, 5.4 years). Estimated freedom from conduit explantation was 88.0% +/- 6.8%, and pulmonary insufficiency was less than or equal to mild in 75.0% at 10 years. All valves maintained their motion, and the mean estimated pressure gradient across the conduit was 19.6 +/- 11.9 mm Hg at 5 years and appeared to reach a plateau thereafter. The pressure gradient across the conduit was 14.2 +/- 8.0 mm Hg at 3 years (P = .0127) and 18.1 +/- 7.5 mm Hg at 7 years (P = .0208). Polytetrafluoroethylene conduits represent a valid option and reliable alternative to homograft and xenograft implantation for pulmonary reconstruction.The Journal of thoracic and cardiovascular surgery 02/2009; 137(1):124-31. DOI:10.1016/j.jtcvs.2008.08.060 · 4.17 Impact Factor
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