Advertisement

Expanded Polytetrafluoroethylene Conduits With Bulging Sinuses and a Fan-Shaped Valve in Right Ventricular Outflow Tract Reconstruction

      We developed a handmade expanded polytetrafluoroethylene (ePTFE) pulmonary valvular conduit (PVC) with bulging sinuses and a fan-shaped ePTFE valve for right ventricular outflow tract (RVOT) reconstruction. We aimed to investigate the results of this device in this multicenter study. From 2001 to 2020, 1776 patients underwent RVOT reconstruction using ePTFE PVCs at 65 institutions in Japan. The median age and body weight were 4.1 years (range, 3 days to 67.1 years) and 13.3 (range, 1.8–91.3) kg, respectively. The median PVC size was 18 (range, 8–24) mm. The median Z-value of the ePTFE PVC was 1.1 (range, −3.8 to 5.0). The ePTFE PVC conditions were investigated by cardiac echocardiography and catheterization. The median follow-up period was 3.3 years (range, 0 day to 16.2 years). There were only 9 cases (0.5%) with PVC-related unknown deaths. Reintervention was performed in 283 patients (15.9%), and 190 patients (10.7%) required explantation. Freedom from reintervention and explantation at 5/10 years were 86.7/61.5% and 93.0/69.1%, respectively. At the latest echocardiography, PVC regurgitation grade was better than mild in 88.4% patients. The average peak RVOT gradient was 15.7 ± 15.9 mm Hg at the latest cardiac catheterization. ePTFE PVC infection was detected in only 8 patients (0.5%). Relative stenosis due to somatic growth was the most common cause of PVC explantation. The performance of ePTFE in terms of durability, valvular performance, and the resistance against infection is considerable and may replace conventional prosthetic materials. Further improvement of the ePTFE membrane is essential to prevent valvular dysfunction.

      Keywords

      Abbreviations:

      RVOT (right ventricular outflow tract), TOF (tetralogy of Fallot), PA (pulmonary artery), PVC (pulmonary valved conduit), RV (right ventricle), ePTFE (expanded polytetrafluoroethylene), PS (pulmonary stenosis), TGA (Transposition of the great arteries), PPVI (percutaneous pulmonary valve implantation)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Seminars in Thoracic and Cardiovascular Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Sandica E.
        • Boethig D.
        • Blanz U.
        • et al.
        Bovine jugular veins versus homografts in the pulmonary position: an analysis across two centers and 711 patients-conventional comparisons and time status graphs as a new approach.
        Thorac Cardiovasc Surg. 2016; 64: 25-35
        • Christenson J.T.
        • Sierra J.
        • Colina Manzano N.E.
        • et al.
        Homografts and xenografts for right ventricular outflow tract reconstruction: Long-term results.
        Ann Thorac Surg. 2010; 90: 1287-1293
        • Poynter J.A.
        • Eghtesady P.
        • McCrindle B.W.
        • et al.
        Association of pulmonary conduit type and size with durability in infants and young children.
        Ann Thorac Surg. 2013; 96: 1695-1702
        • Mokhles M.M.
        • Charitos E.I.
        • Stierle U.
        • et al.
        The fate of pulmonary conduits after the Ross procedure: Longitudinal analysis of the German-Dutch Ross registry experience.
        Heart. 2013; 99: 1857-1866
        • Yamagishi M.
        Right ventricular outflow reconstruction using a polytetrafluoroethylene conduit with bulging sinuses and tricuspid fan-shaped polytetrafluoroethylene valve.
        Oper Tech Thorac Cardiovasc Surg. 2016; 21: 211-229
        • Miyazaki T.
        • Yamagishi M.
        • Maeda Y.
        • et al.
        Long-term outcomes of expanded polytetrafluoroethylene conduits with bulging sinuses and a fan-shaped valve in right ventricular outflow tract reconstruction.
        J Thorac Cardiovasc Surg. 2018; 155: 2567-2576
        • Yamagishi M.
        • Kurosawa H.
        Outflow reconstruction of tetralogy of Fallot using a Gore-Tex valve.
        Ann Thorac Surg. 1993; 56: 1414-1417
        • Baumgartner H.
        • Hung J.
        • Bermejo J.
        • et al.
        Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice.
        Eur J Echocardiogr. 2009; 10: 1-25
        • Kirklin J.W.
        • Blackstone E.H.
        • Jonas R.A.
        • Kouchoukos N.T.
        Anatomy, dimensions, and terminology.
        in: Kirklin J.W. Barratt-Boyes B.G. Cardiac surgery. 3rd ed. Churchill Livingstone, Edinburgh2004: 50
        • Akins C.W.
        • Miller D.C.
        • Turina M.I.
        • et al.
        Guidelines for reporting mortality and morbidity after cardiac valve interventions.
        J Thorac Cardiovasc Surg. 2008; 135: 732-738
        • Balzer D.
        Pulmonary valve replacement for Tetralogy of Fallot.
        Methodist Debakey Cardiovasc J. 2019; 15: 122-132
        • Mercer C.W.
        • West S.C.
        • Sharma M.S.
        • et al.
        Polytetrafluoroethylene conduits versus homografts for right ventricular outflow tract reconstruction in infants and young children: an institutional experience.
        J Thorac Cardiovasc Surg. 2018; 155: 2082-2091
        • Shebani S.O.
        • McGuirk S.
        • Baghai M.
        • et al.
        Right ventricular outflow tract reconstruction using Contegra valved conduit: natural history and conduit performance under pressure.
        Eur J Cardiothorac Surg. 2006; 29: 397-405
        • Gober V.
        • Berdat P.
        • Pavlovic M.
        • et al.
        Adverse mid-term outcome following RVOT reconstruction using the Contegra valved bovine jugular vein.
        Ann Thorac Surg. 2005; 79: 623-625
        • Meyns B.
        • Garsse L.V.
        • Boshoff D.
        • et al.
        The Contegra conduit in the right ventricular outflow tract induces supravalvular stenosis.
        J Thorac Cardiovasc Surg. 2004; 128: 834-840
        • Zhang H.F.
        • Chen G.
        • Ye M.
        • et al.
        Mid- to long-term outcomes of bovine jugular vein conduit implantation in Chinese children.
        J Thorac Dis. 2017; 9: 1234-1239
        • Mery C.M.
        • Guzmán-Pruneda F.A.
        • De León L.E.
        • et al.
        Risk factors for development of endocarditis and reintervention in patients undergoing right ventricle to pulmonary artery valved conduit placement.
        J Thorac Cardiovasc Surg. 2016; 151: 432-441
        • Albanesi F.
        • Sekarski N.
        • Lambrou D.
        • et al.
        Incidence and risk factors for Contegra graft infection following right ventricular outflow tract recon- struction: long-term results.
        Eur J Cardiothorac Surg. 2014; 45: 1070-1074
        • Habib G.
        • Hoen B.
        • Tornos P.
        • et al.
        Guidelines on the prevention, diagnosis, and treatment of infective endocarditis (new version 2009): The task force on the prevention, diagnosis, and treatment of infective endocarditis of the European Society of Cardiology (ESC). Endorsed by the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and the International Society of Chemotherapy (ISC) for infection and cancer.
        Eur Heart J. 2009; 30: 2369-2413
        • Jewgenow P.
        • Schneider H.
        • Bökenkamp R.
        • et al.
        Subclinical thrombus formation in bioprosthetic pulmonary valve conduits.
        Int J Cardiol. 2019; 281: 113-118
        • Suzuki I.
        • Shiraishi Y.
        • Yabe S.
        • et al.
        Engineering analysis of the effects of bulging sinuses in a newly designed pediatric pulmonary heart valve on hemodynamic function.
        J Artif Organs. 2012; 15: 49-56
        • Shinkawa T.
        • Tang X.
        • Gossett J.M.
        • et al.
        Valved polytetrafluoroethylene conduits for right ventricular outflow tract reconstruction.
        Ann Thorac Surg. 2015; 100: 129-137
        • Tsuboko Y.
        • Shiraishi Y.
        • Yamada A.
        • et al.
        Engineering based assessment for a shape design of a pediatric ePTFE pulmonary conduit valve.
        Conf Proc IEEE Eng Med Biol Soc. 2016; 2016: 4313-4316
        • Ando M.
        • Takahashi Y.
        Ten-year experience with handmade trileaflet polytetrafluoroethylene valved conduit used for pulmonary reconstruction.
        J Thorac Cardiovasc Surg. 2009; 137: 124-131
        • Zhang H.
        • Ye M.
        • Chen G.
        • et al.
        0.1 mm ePTFE versus autologous pericardium for hand-sewn trileaflet valved conduit: A comparative study.
        J Artif Organs. 2019; 22: 207-213
        • Ebbers T.
        Flow imaging: cardiac applications of 3D cine phase-contrast MRI.
        Curr Cardiovasc Imaging Rep. 2011; 4: 127-133
        • Itatani K.
        • Miyazaki S.
        • Furusawa T.
        • et al.
        New imaging tools in cardiovascular medicine: Computational fluid dynamics and 4D flow MRI.
        Gen Thorac Cardiovasc Surg. 2017; 65: 611-621
        • Ootaki Y.
        • Welch A.S.
        • Walsh M.J.
        • et al.
        Medium-term outcomes after implantation of expanded polytetrafluoroethylene valved conduit.
        Ann Thorac Surg. 2018; 105: 843-850
        • Yamashita E.
        • Yamagishi M.
        • Miyazaki T.
        • et al.
        Smaller-sized expanded polytetrafluoroethylene conduits with a fan-shaped valve and bulging sinuses for right ventricular outflow tract reconstruction.
        Ann Thorac Surg. 2016; 102: 1336-1344
        • Sfyridis P.G.
        • Avramidis D.P.
        • Kirvassilis G.V.
        • et al.
        The contegra® valved heterograft conduit for right ventricular outflow tract reconstruction: A reliable solution.
        Hellenic J Cardiol. 2011; 52: 501-508
        • Yamamoto Y.
        • Yamagishi M.
        • Maeda Y.
        • et al.
        Histopathologic analysis of explanted polytetrafluoroethylene-valved pulmonary conduits.
        Semin Thorac Cardiovasc Surg. 2019; (S1043-0679(19)30317-X)

      Linked Article

      • Commentary: Right Ventricular Outflow Tract Reconstruction: Many Imperfect Options?
        Seminars in Thoracic and Cardiovascular SurgeryVol. 34Issue 3
        • Preview
          In this issue of Seminars in Thoracic and Cardiovascular Surgery, Hongu and colleagues from Kyoto Prefectural University of Medicine in Kyoto, Japan, present their experience with expanded polytetrafluoroethylene conduits with bulging sinuses and a fan-shaped valve (ePTFE) in right ventricular outflow tract (RVOT) reconstruction.1 The manuscript is an extension of previous work, reported in the Journal of Thoracic and Cardiovascular Surgery in 2018.2 In this new manuscript, the authors report on a considerably larger cohort of patients, 1776 compared to 902, and provide a more detailed analysis, focused on freedom explantation or reintervention on the conduits based on survey responses from multiple sites.
        • Full-Text
        • PDF
      • Commentary: The Crow and the Pitcher - Necessity is the Mother of Invention for Right Ventricular Outflow Tract Reconstruction
        Seminars in Thoracic and Cardiovascular SurgeryVol. 34Issue 3
        • Preview
          In Aesop's fable of the Crow and the Pitcher,1 a thirsty bird uses ingenuity to drop pebbles into a pitcher to allow the water level to rise so it may drink. With regards to options for valved-conduits for RVOT intervention, similar innovation is required due the known limitations of homografts, xeno/heterografts, and mechanical valved-conduits. The team from Kyoto has designed an expanded polytetrafluoroethylene (ePTFE) conduit with bulging sinuses and a hand-sewn fan-shaped valve (BSFSV) aimed at generating a vortex flow similar to that created by native sinuses of Valsalva.
        • Full-Text
        • PDF