Application of bicuspid pulmonary valve sewn by 0.1 mm expanded polytetrafluoroethylene in right ventricle outflow tract reconstruction_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

MA Jianrui ^1,2 , TAN Tong ^1,2 , TIAN Miao ¹ , TU Jiazichao ¹ , XIE Wen ¹ , QIU Hailong ¹ , ZHANG Shuai ¹ , ZHUANG Jian ¹ , CHEN Jimei ¹ , CEN Jianzheng ¹ , WEN Shusheng ¹ ,  YUAN Haiyun ¹ ,  LIU Xiaobing ¹

1. Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510800, P. R. China;
2. Shantou University Medical College, Shantou, 515041, Guangdong, P. R. China;

Corresponding author：

YUAN Haiyun, Email: yhy_yun@163.com; LIU Xiaobing, Email: liuxb21@aliyun.com

Keywords：

Right ventricular outflow tract obstruction; pulmonary regurgitation; polytetrafluoroethylene; valved conduit; congenital heart diseases

DOI：

10.7507/1007-4848.202306050

Video：

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Objective To introduce a modified technique of right ventricular outflow tract (RVOT) reconstruction using a handmade bicuspid pulmonary valve crafted from expanded polytetrafluoroethylene (ePTFE) and to summarize the early single-center experience. Methods Patients with complex congenital heart disease (CHD) who underwent RVOT reconstruction with a handmade ePTFE bicuspid pulmonary valve due to pulmonary regurgitation at Guangdong Provincial People’s Hospital from April 2021 to February 2022 were selected. Postoperative artificial valve function and right heart function indicators were evaluated. Results A total of 17 patients were included, comprising 10 males and 7 females, with a mean age of (18.18±12.14) years and a mean body weight of (40.94±19.45) kg. Sixteen patients underwent reconstruction with a handmade valved conduit, with conduit sizes ranging from 18 to 24 mm. No patients required mechanical circulatory support, and no in-hospital deaths occurred. During a mean follow-up period of 12.89 months, only one patient developed valve dysfunction, and no related complications or adverse events were observed. The degree of pulmonary regurgitation was significantly improved post-RVOT reconstruction and during follow-up compared to preoperative levels (P<0.001). Postoperative right atrial diameter, right ventricular diameter, and tricuspid regurgitation area were all significantly reduced compared to preoperative values (P<0.05). Conclusion The use of a 0.1 mm ePTFE handmade bicuspid pulmonary valve for RVOT reconstruction in complex CHD is a feasible, effective, and safe technique.

1.	Boethig D, Thies WR, Hecker H, et al. Mid term course after pediatric right ventricular outflow tract reconstruction: a comparison of homografts, porcine xenografts and Contegras. Eur J Cardiothorac Surg, 2005, 27(1): 58-66.
2.	Miyazaki T, Yamagishi M, Yamamoto Y, et al. Use of an expanded polytetrafluoroethylene valved patch with a sinus in right ventricular outflow tract reconstruction. Eur J Cardiothorac Surg, 2019, 56(4): 671-678.
3.	Yamagishi M, Kurosawa H. Outflow reconstruction of tetralogy of Fallot using a Gore-Tex valve. Ann Thorac Surg, 1993, 56(6): 1414-1416.
4.	Turrentine MW, McCarthy RP, Vijay P, et al. PTFE monocusp valve reconstruction of the right ventricular outflow tract. Ann Thorac Surg, 2002, 73(3): 871-879.
5.	Ootaki Y, Welch AS, Walsh MJ, et al. Medium-term outcomes after implantation of expanded polytetrafluoroethylene valved conduit. Ann Thorac Surg, 2018, 105(3): 843-850.
6.	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(6): 2567-2576.
7.	Hongu H, Yamagishi M, Maeda Y, et al. Expanded polytetrafluoroethylene conduits with bulging sinuses and a fan-shaped valve in right ventricular outflow tract reconstruction. Semin Thorac Cardiovasc Surg, 2022, 34(3): 972-980.
8.	Romeo JLR, Takkenberg JJM, Roos-Hesselink JW, et al. Outcomes of pregnancy after right ventricular outflow tract reconstruction with an allograft conduit. J Am Coll Cardiol, 2018, 71(23): 2656-2665.
9.	Nath DS, Nussbaum DP, Yurko C, et al. Pulmonary homograft monocusp reconstruction of the right ventricular outflow tract: outcomes to the intermediate term. Ann Thorac Surg, 2010, 90(1): 42-49.
10.	刘学刚, 武开宏, 施超, 等. 自体心包同时扩大肺动脉瓣环与瓣膜技术重建右室流出道的临床研究. 中华医学杂志, 2007, 87(8): 553-555.Liu XG, Wu KH, Shi C, et al. The clinical results of right ventricular outflow tract reconstruction with a transannular patch of autologous pericardium. Natl Med J China, 2007, 87(8): 553-555.
11.	Takahashi Y, Tsutsumi Y, Monta O, et al. Expanded polytetrafluoroethylene-valved conduit with bulging sinuses for right ventricular outflow tract reconstruction in adults. Gen Thorac Cardiovasc Surg, 2010, 58(1): 14-18.
12.	Yoshida M, Wearden PD, Dur O, et al. Right ventricular outflow tract reconstruction with bicuspid valved polytetrafluoroethylene conduit. Ann Thorac Surg, 2011, 91(4): 1235-1238.
13.	Rawat S, Jaswal V, Thingnam SKS, et al. Short-term outcome of polytetrafluoroethylene membrane valve versus transannular pericardial patch reconstruction of right ventricular outflow tract in tetralogy of Fallot: a randomized controlled trial. Braz J Cardiovasc Surg, 2021, 36(1): 39-47.
14.	Choi KH, Sung SC, Kim H, et al. Late results of right ventricular outflow tract reconstruction with a bicuspid expanded polytetrafluoroethylene valved conduit. J Card Surg, 2018, 33(1): 36-40.
15.	Quintessenza JA, Jacobs JP, Morell VO, et al. Initial experience with a bicuspid polytetrafluoroethylene pulmonary valve in 41 children and adults: a new option for right ventricular outflow tract reconstruction. Ann Thorac Surg, 2005, 79(3): 924-931.
16.	Baird CW, Chávez M, Sleeper LA, et al. Reintervention rates after bioprosthetic pulmonary valve replacement in patients younger than 30 years of age: a multicenter analysis. J Thorac Cardiovasc Surg, 2021, 161(2): 345-362.

1. Boethig D, Thies WR, Hecker H, et al. Mid term course after pediatric right ventricular outflow tract reconstruction: a comparison of homografts, porcine xenografts and Contegras. Eur J Cardiothorac Surg, 2005, 27(1): 58-66.
2. Miyazaki T, Yamagishi M, Yamamoto Y, et al. Use of an expanded polytetrafluoroethylene valved patch with a sinus in right ventricular outflow tract reconstruction. Eur J Cardiothorac Surg, 2019, 56(4): 671-678.
3. Yamagishi M, Kurosawa H. Outflow reconstruction of tetralogy of Fallot using a Gore-Tex valve. Ann Thorac Surg, 1993, 56(6): 1414-1416.
4. Turrentine MW, McCarthy RP, Vijay P, et al. PTFE monocusp valve reconstruction of the right ventricular outflow tract. Ann Thorac Surg, 2002, 73(3): 871-879.
5. Ootaki Y, Welch AS, Walsh MJ, et al. Medium-term outcomes after implantation of expanded polytetrafluoroethylene valved conduit. Ann Thorac Surg, 2018, 105(3): 843-850.
6. 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(6): 2567-2576.
7. Hongu H, Yamagishi M, Maeda Y, et al. Expanded polytetrafluoroethylene conduits with bulging sinuses and a fan-shaped valve in right ventricular outflow tract reconstruction. Semin Thorac Cardiovasc Surg, 2022, 34(3): 972-980.
8. Romeo JLR, Takkenberg JJM, Roos-Hesselink JW, et al. Outcomes of pregnancy after right ventricular outflow tract reconstruction with an allograft conduit. J Am Coll Cardiol, 2018, 71(23): 2656-2665.
9. Nath DS, Nussbaum DP, Yurko C, et al. Pulmonary homograft monocusp reconstruction of the right ventricular outflow tract: outcomes to the intermediate term. Ann Thorac Surg, 2010, 90(1): 42-49.
10. 刘学刚, 武开宏, 施超, 等. 自体心包同时扩大肺动脉瓣环与瓣膜技术重建右室流出道的临床研究. 中华医学杂志, 2007, 87(8): 553-555.Liu XG, Wu KH, Shi C, et al. The clinical results of right ventricular outflow tract reconstruction with a transannular patch of autologous pericardium. Natl Med J China, 2007, 87(8): 553-555.
11. Takahashi Y, Tsutsumi Y, Monta O, et al. Expanded polytetrafluoroethylene-valved conduit with bulging sinuses for right ventricular outflow tract reconstruction in adults. Gen Thorac Cardiovasc Surg, 2010, 58(1): 14-18.
12. Yoshida M, Wearden PD, Dur O, et al. Right ventricular outflow tract reconstruction with bicuspid valved polytetrafluoroethylene conduit. Ann Thorac Surg, 2011, 91(4): 1235-1238.
13. Rawat S, Jaswal V, Thingnam SKS, et al. Short-term outcome of polytetrafluoroethylene membrane valve versus transannular pericardial patch reconstruction of right ventricular outflow tract in tetralogy of Fallot: a randomized controlled trial. Braz J Cardiovasc Surg, 2021, 36(1): 39-47.
14. Choi KH, Sung SC, Kim H, et al. Late results of right ventricular outflow tract reconstruction with a bicuspid expanded polytetrafluoroethylene valved conduit. J Card Surg, 2018, 33(1): 36-40.
15. Quintessenza JA, Jacobs JP, Morell VO, et al. Initial experience with a bicuspid polytetrafluoroethylene pulmonary valve in 41 children and adults: a new option for right ventricular outflow tract reconstruction. Ann Thorac Surg, 2005, 79(3): 924-931.
16. Baird CW, Chávez M, Sleeper LA, et al. Reintervention rates after bioprosthetic pulmonary valve replacement in patients younger than 30 years of age: a multicenter analysis. J Thorac Cardiovasc Surg, 2021, 161(2): 345-362.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

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