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.



      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)
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      Linked Article

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        Seminars in Thoracic and Cardiovascular SurgeryVol. 34Issue 3
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          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.
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      • 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
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          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.
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