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Malankar DP, Dhake S, Mhatre A, Soni B, Kandavel D, Bamne S, Garekar S. Handmade Bicuspid Valved Polytetrafluoroethylene Conduit for Right Ventricular Outflow Tract Reconstruction. World J Pediatr Congenit Heart Surg 2024; 15:453-458. [PMID: 38454615 DOI: 10.1177/21501351241227908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
Background: Excellent outcomes of right ventricle to pulmonary artery conduits with polytetrafluoroethylene (PTFE) valves have been reported. The purpose of this study was to analyze the short-term results of our handmade PTFE bicuspid valved conduit (VC) for right ventricular outflow tract reconstruction. Methods: Between September 2019 and May 2023, bicuspid PTFE-VC was implanted in 17 patients at a median age of 2.5 years (range, 3 months to 13.6 years). The PTFE-VC was fashioned from a commercially available PTFE tube graft (14 mm in three patients, 16 mm in three patients, 18 mm in one patient, 20 mm in three patients, and 22 mm in seven patients) and 0.1 mm thick PTFE membrane for the leaflet material. Valve function was assessed by echocardiogram after the implantation. The conduit reoperation and the conduit dysfunction were analyzed. There were no early deaths, but there was one late death. Results: There were no postoperative in-hospital deaths. Follow-up echocardiograms were available for 14 of 17 patients. The median follow-up was 21 months (range, 7-49 months). Conduit stenosis was none or trivial in 11 patients while it was mild in two and moderate in one patient and severe in 0 patients. Conduit insufficiency was mild or trivial in all 14 patients. By the end of the study period, freedom from reoperation/reintervention was 100%. There were no episodes of aneurysmal dilatation of the conduit or endocarditis. Conclusions: Handmade bicuspid PTFE VC shows good short-term outcome, with no significant valve dysfunction and no reintervention. A longer follow-up is necessary to evaluate the long-term advantages of using the handmade bicuspid PTFE VC.
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Affiliation(s)
- Dhananjay P Malankar
- Department of Paediatric Cardiac Surgery, Fortis Paediatric and Congenital Heart Centre, Mulund, Mumbai, India
| | - Shyam Dhake
- Department of Paediatric Cardiac Anaesthesia and Critical Care, Fortis Paediatric and Congenital Heart Centre, Mulund, Mumbai, India
| | - Amit Mhatre
- Department of Paediatric Cardiac Anaesthesia and Critical Care, Fortis Paediatric and Congenital Heart Centre, Mulund, Mumbai, India
| | - Bharat Soni
- Department of Paediatric Cardiac Surgery, Fortis Paediatric and Congenital Heart Centre, Mulund, Mumbai, India
| | - Dinesh Kandavel
- Department of Paediatric Cardiac Surgery, Fortis Paediatric and Congenital Heart Centre, Mulund, Mumbai, India
| | - Sujit Bamne
- Department of Perfusion Technology, Fortis Paediatric and Congenital Heart Centre, Mulund, Mumbai, India
| | - Swati Garekar
- Department of Paediatric Cardiology, Fortis Paediatric and Congenital Heart Centre, Mulund, Mumbai, India
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Rezvova MA, Klyshnikov KY, Gritskevich AA, Ovcharenko EA. Polymeric Heart Valves Will Displace Mechanical and Tissue Heart Valves: A New Era for the Medical Devices. Int J Mol Sci 2023; 24:ijms24043963. [PMID: 36835389 PMCID: PMC9967268 DOI: 10.3390/ijms24043963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 02/12/2023] [Accepted: 02/14/2023] [Indexed: 02/18/2023] Open
Abstract
The development of a novel artificial heart valve with outstanding durability and safety has remained a challenge since the first mechanical heart valve entered the market 65 years ago. Recent progress in high-molecular compounds opened new horizons in overcoming major drawbacks of mechanical and tissue heart valves (dysfunction and failure, tissue degradation, calcification, high immunogenic potential, and high risk of thrombosis), providing new insights into the development of an ideal artificial heart valve. Polymeric heart valves can best mimic the tissue-level mechanical behavior of the native valves. This review summarizes the evolution of polymeric heart valves and the state-of-the-art approaches to their development, fabrication, and manufacturing. The review discusses the biocompatibility and durability testing of previously investigated polymeric materials and presents the most recent developments, including the first human clinical trials of LifePolymer. New promising functional polymers, nanocomposite biomaterials, and valve designs are discussed in terms of their potential application in the development of an ideal polymeric heart valve. The superiority and inferiority of nanocomposite and hybrid materials to non-modified polymers are reported. The review proposes several concepts potentially suitable to address the above-mentioned challenges arising in the R&D of polymeric heart valves from the properties, structure, and surface of polymeric materials. Additive manufacturing, nanotechnology, anisotropy control, machine learning, and advanced modeling tools have given the green light to set new directions for polymeric heart valves.
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Affiliation(s)
- Maria A. Rezvova
- Research Institute for Complex Issues of Cardiovascular Diseases, 650002 Kemerovo, Russia
| | - Kirill Y. Klyshnikov
- Research Institute for Complex Issues of Cardiovascular Diseases, 650002 Kemerovo, Russia
| | | | - Evgeny A. Ovcharenko
- Research Institute for Complex Issues of Cardiovascular Diseases, 650002 Kemerovo, Russia
- Correspondence:
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Tocharoenchok T, Siriprompatr S, Subtaweesin T, Tantiwongkosri K, Nitiyarom E, Sriyoschati S. Early Outcome of Simplified Standardized Trileaflet Polytetrafluoroethylene Valved Conduit Placement. World J Pediatr Congenit Heart Surg 2022; 13:723-730. [DOI: 10.1177/21501351221117707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Use of the expanded polytetrafluoroethylene (ePTFE) valved conduit in the pulmonary position during the correction of congenital heart defects has significantly increased in popularity over the last decade due to its promising conduit longevity. We describe the standardized process to create and implant a trileaflet ePTFE pulmonary conduit along with the early outcomes of such procedures at our institute. Methods Records of 100 consecutive patients who underwent ePTFE valved conduit placement using our technique from April 2018 through February 2022 were retrospectively analyzed. The function of the conduit was evaluated by transthoracic echocardiography. Results The mean age of the patients was 28 ± 13.2 years old at the time of the operation. The conduit diameters ranged from 16 to 24 mm (mean 23.0 ± 1.9 mm). Conduit placement was utilized for pulmonary valve replacement in 68 patients, conduit change in 25 patients, and as a part of total repair in 7 patients. There were 2 in-hospital conduit-unrelated deaths from multi-organ dysfunction and pulmonary hypertensive crisis. From the postoperative echocardiography, the average peak pressure gradient across the conduit was 18.6 ± 9.0 mm Hg, and the conduit regurgitation was graded as none or trace in 81 patients, mild in 17 patients, and moderate in 2 patients. At 589 days of median follow-up, there was no conduit reoperation. Follow-up imaging of 60 available patients at a median time of 511 days did not show a significant change in conduit function. Conclusions Our standardized ePTFE valved conduit creation and placement demonstrated satisfactory clinical and echocardiographic outcomes.
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Affiliation(s)
- Teerapong Tocharoenchok
- Division of Cardiothoracic Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Suthida Siriprompatr
- Division of Cardiothoracic Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Thaworn Subtaweesin
- Division of Cardiothoracic Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kriangkrai Tantiwongkosri
- Division of Cardiothoracic Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Ekarat Nitiyarom
- Division of Cardiothoracic Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Somchai Sriyoschati
- Division of Cardiothoracic Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Yuan H, Lu T, Wu Z, Yang Y, Chen J, Wu Q, Wu S, Zhang H, Qian T, Huang C. Decellularized bovine jugular vein and hand-sewn ePTFE valved conduit for right ventricular outflow tract reconstruction in children undergoing Ross procedure. Front Cardiovasc Med 2022; 9:956301. [PMID: 36158834 PMCID: PMC9489926 DOI: 10.3389/fcvm.2022.956301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 08/12/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe Ross procedure is recommended as an optimal aortic valve replacement (AVR) in children and young adults due to several advantages. Nevertheless, multiple reconstructions of the right ventricular outflow tract (RVOT) with new valve conduits have caused some concern regarding the durability of the Ross AVR. Decellularized bovine jugular vein conduit (BJVC) (DP-BJVC) and hand-sewn expanded polytetrafluoroethylene valved conduits (ePTFE VC) are widely employed to reconstruct the RVOT with satisfactory long-term outcomes. However, few studies have compared the safety and efficacy between the two valve conduits. We aimed to evaluate the early outcomes and report our single center experience in the application of these conduits.MethodsTwenty-two pediatric patients (aged < 18 years) who underwent Ross procedures with DP-BJVC and ePTFE VC in our center between 1 June, 2017 and 31 January, 2022 were enrolled. The Kaplan–Meier method was used to evaluate survival, freedom from RVOT reintervention, and freedom from RVOT graft dysfunction. Mixed-effects analysis with the Geisser–Greenhouse correction and Sidak's multiple comparisons test for post-hoc analysis was employed to compare the peak gradient across the conduit at varying follow-ups.ResultsAll patients were followed up in full. The total early survival rate was 90.9%; two patients in the DP-BJVC group died. There was no significant difference in early mortality, cross-clamp time (p = 0.212), in-hospital stay (p = 0.469), and RVOT graft thrombosis or endocarditis between the two groups. There was similarly no significant difference between Kaplan–Meier freedom from RVOT graft dysfunction curve (P = 0.131). The transprosthetic gradient gradually increased over time in both groups and was significantly higher in the DP-BJVC group at follow-up (P < 0.05).ConclusionsBoth conduits show excellent early and midterm outcomes for RVOT reconstruction in the Ross procedure. We suggest that DP-BJVC is more suitable for infants, and ePTFE conduit is more suitable for older children who require larger conduits.
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Affiliation(s)
- Haoyong Yuan
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
- Engineering Laboratory of Hunan Province for Cardiovascular Biomaterials, Changsha, China
| | - Ting Lu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
- Engineering Laboratory of Hunan Province for Cardiovascular Biomaterials, Changsha, China
| | - Zhongshi Wu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
- Engineering Laboratory of Hunan Province for Cardiovascular Biomaterials, Changsha, China
| | - Yifeng Yang
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Jinlan Chen
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Qin Wu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Sijie Wu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Hong Zhang
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Tao Qian
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Can Huang
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
- Engineering Laboratory of Hunan Province for Cardiovascular Biomaterials, Changsha, China
- *Correspondence: Can Huang
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Wang GX, Mao FQ, Ma K, Liu R, Pang KJ, Zhang S, Yang Y, Zhang BQ, Li SJ. Handmade tri-leaflet ePTFE conduits versus homografts for right ventricular outflow tract reconstruction. World J Pediatr 2022; 18:206-213. [PMID: 35066802 DOI: 10.1007/s12519-021-00498-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 12/02/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND This study aimed to investigate the performance of handmade tri-leaflet expanded polytetrafluoroethylene (ePTFE) conduits in the absence of a suitable homograft. METHODS Patients who underwent right ventricular outflow tract reconstruction with tri-leaflet ePTFE conduits or homografts between December 2016 and August 2020 were included. The primary endpoint was the incidence of moderate or severe conduit stenosis (≥ 36 mmHg) and/or moderate or severe insufficiency. The secondary endpoint was the incidence of severe conduit stenosis (≥ 64 mmHg) and/or severe insufficiency. RESULTS There were 102 patients in the ePTFE group and 52 patients in the homograft group. The median age was younger [34.5 (interquartile range: 20.8-62.8) vs. 60.0 (interquartile range: 39.3-81.0) months, P = 0.001] and the median weight was lower [13.5 (10.0-19.0) vs. 17.8 (13.6-25.8) kg, P = 0.003] in the ePTFE group. The conduit size was smaller (17.9 ± 2.2 vs. 20.5 ± 3.0 mm, P < 0.001) and the conduit Z score was lower (1.48 ± 1.04 vs. 1.83 ± 1.05, P = 0.048) in the ePTFE group. There was no significant difference in the primary endpoints (log rank, P = 0.33) and secondary endpoints (log rank, P = 0.35). Multivariate analysis identified lower weight at surgery [P = 0.01; hazard ratio: 0.75; 95% confidence interval (CI) 0.59-0.94] and homograft conduit use (P = 0.04; hazard ratio: 8.43; 95% CI 1.14-62.29) to be risk factors for moderate or severe conduit insufficiency. No risk factors were found for moderate or severe conduit stenosis or conduit dysfunction on multivariate analysis. CONCLUSION Handmade tri-leaflet ePTFE conduits showed acceptable early and midterm outcomes in the absence of a suitable homograft, but a longer follow-up is needed.
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Affiliation(s)
- Guan-Xi Wang
- National Center for Cardiovascular Diseases, Pediatric Cardiac Center, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Street, Xicheng District, Beijing 100037, China
| | - Feng-Qun Mao
- National Center for Cardiovascular Diseases, Pediatric Cardiac Center, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Street, Xicheng District, Beijing 100037, China
| | - Kai Ma
- National Center for Cardiovascular Diseases, Pediatric Cardiac Center, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Street, Xicheng District, Beijing 100037, China
| | - Rui Liu
- National Center for Cardiovascular Diseases, Pediatric Cardiac Center, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Street, Xicheng District, Beijing 100037, China
| | - Kun-Jing Pang
- Department of Echocardiography, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Street, Xicheng District, Beijing 100037, China
| | - Sen Zhang
- National Center for Cardiovascular Diseases, Pediatric Cardiac Center, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Street, Xicheng District, Beijing 100037, China
| | - Yang Yang
- National Center for Cardiovascular Diseases, Pediatric Cardiac Center, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Street, Xicheng District, Beijing 100037, China
| | - Ben-Qing Zhang
- National Center for Cardiovascular Diseases, Pediatric Cardiac Center, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Street, Xicheng District, Beijing 100037, China
| | - Shou-Jun Li
- National Center for Cardiovascular Diseases, Pediatric Cardiac Center, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Street, Xicheng District, Beijing 100037, China. .,Department of Pediatric Cardiac Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing 100037, China.
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Shi Q, Shan Y, Chen G, Mi Y, Zhong H, Jia B, Zhang H. Mid-term Outcomes for Polytetrafluoroethylene Valved Conduits. Ann Thorac Surg 2021; 114:1778-1785. [PMID: 34717907 DOI: 10.1016/j.athoracsur.2021.09.051] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 09/10/2021] [Accepted: 09/20/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Various conduits for right ventricular outflow tract reconstruction (RVOTR) have been reported but most of them are not available in China. We developed a simple handsewn valved conduit using expanded polytetrafluoroethylene (ePTFE). This study evaluated the mid-term outcomes for this conduit. METHODS This retrospective study included a total of 72 patients who underwent RVOTR with ePTFE valved conduits between January 2014 and June 2020. During follow-up, echocardiograms were performed for all patients and magnetic resonance imaging for patients with repaired Fallot. RESULTS Patients had a median age of 69 (interquartile range, 28-127) months and a median follow-up period of 33 (interquartile range, 9-51) months . There was no early death , but two late deaths (2.78%) occurred. The median conduit size was 18 mm (interquartile range, 18-20) and Z score was +1.3 (interquartile range, +0.6-+2). Peak velocity across the ePTFE valve was 2.38 m/s (95% confidence interval, 2.11 - 2.63 m/s). Pulmonary valve regurgitation was none or trivial in 27 (38.5%) patients, mild in 42 (60.0%) patients and moderate in one (1.4%) patient. Conduit dysfunction occurred in five patients: four developed moderate conduit stenosis and one moderate regurgitation. The right ventricular end diastolic volume index in repaired Fallot was significantly decreased after surgery(171 ml/m2 vs 130 ml/m2, P<0.001).No reintervention or conduit replacement was needed. CONCLUSIONS The handsewn ePTFE valved conduit we developed has appreciable hemodynamic outcomes during the mid-term follow-up period. Long-term follow-up studies are needed to corroborate our findings.
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Affiliation(s)
- Qiqi Shi
- Department of Cardiothoracic Surgery, Children's Hospital of Fudan University, Shanghai, China
| | - Yaping Shan
- Department of Cardiothoracic Surgery, Children's Hospital of Fudan University, Shanghai, China
| | - Gang Chen
- Department of Cardiothoracic Surgery, Children's Hospital of Fudan University, Shanghai, China
| | - Yaping Mi
- Department of Cardiothoracic Surgery, Children's Hospital of Fudan University, Shanghai, China
| | - Hui Zhong
- Department of Cardiothoracic Surgery, Children's Hospital of Fudan University, Shanghai, China
| | - Bing Jia
- Department of Cardiothoracic Surgery, Children's Hospital of Fudan University, Shanghai, China
| | - Huifeng Zhang
- Department of Cardiothoracic Surgery, Children's Hospital of Fudan University, Shanghai, China.
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Qian T, Yuan H, Chen C, Liu Y, Lu T, Huang C, Wu Z. Conduits for Right Ventricular Outflow Tract Reconstruction in Infants and Young Children. Front Surg 2021; 8:719840. [PMID: 34631780 PMCID: PMC8492946 DOI: 10.3389/fsurg.2021.719840] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 08/11/2021] [Indexed: 11/21/2022] Open
Abstract
Purpose of Review: Right ventricular outflow tract (RVOT) reconstruction remains a challenge due to the lack of an ideal conduit. Data and experience are accumulating with each passing day. Therefore, it is necessary to review this topic from time to time. This is a 2021 update review focused on the history, evolution, and current situation of small-sized conduits (≤ 16 mm) for RVOT reconstruction in infants and young children. Recent Findings: Currently, the available small-sized (≤16 mm) conduits can meet most clinical needs. Homograft is still a reliable choice for infants and young children validated by a half-century clinical experience. As an alternative material, bovine jugular vein conduit (BJVC) has at least comparable durability with that of homograft. The performance of expanded polytetrafluoroethylene (ePTFE) is amazing in RVOT position according to limited published data. The past century has witnessed much progress in the materials for RVOT reconstruction. However, lack of growth potential is the dilemma for small-sized conduits. Tissue-engineering based on cell-free scaffolds is the most promising technology to obtain the ideal conduit. Summary: No conduit has proved to have lifelong durability in RVOT position. We are far from the ideal, but we are not in a state of emergency. In-depth clinical research as well as innovation in material science are needed to help improve the durability of the conduits used in infants and young children.
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Affiliation(s)
- Tao Qian
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China.,Engineering Laboratory of Hunan Province for Cardiovascular Biomaterials, Changsha, China
| | - Haoyong Yuan
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China.,Engineering Laboratory of Hunan Province for Cardiovascular Biomaterials, Changsha, China
| | - Chunyang Chen
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China.,Engineering Laboratory of Hunan Province for Cardiovascular Biomaterials, Changsha, China
| | - Yuhong Liu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China.,Engineering Laboratory of Hunan Province for Cardiovascular Biomaterials, Changsha, China
| | - Ting Lu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China.,Engineering Laboratory of Hunan Province for Cardiovascular Biomaterials, Changsha, China
| | - Can Huang
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China.,Engineering Laboratory of Hunan Province for Cardiovascular Biomaterials, Changsha, China
| | - Zhongshi Wu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China.,Engineering Laboratory of Hunan Province for Cardiovascular Biomaterials, Changsha, China
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Chang TI, Hsu KH, Li SJ, Chuang MK, Luo CW, Chen YJ, Chang CI. Evolution of pulmonary valve reconstruction with focused review of expanded polytetrafluoroethylene handmade valves. Interact Cardiovasc Thorac Surg 2020; 32:585-592. [PMID: 33377488 DOI: 10.1093/icvts/ivaa302] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/17/2020] [Accepted: 10/04/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Many surgeons develop unique techniques for unmet needs for right ventricular outflow reconstruction to resolve pulmonary regurgitation after corrective surgery for congenital heart diseases. Expanded polytetrafluoroethylene (ePTFE) stands out as a reliable synthetic material, and clinical results with handmade ePTFE valves have been promising. This review focuses on the historical evolution of the use of ePTFE in pulmonary valve replacement and in the techniques for pioneering the translation of the handmade ePTFE trileaflet design for the transcatheter approach. METHODS We searched for and reviewed publications from 1990 to 2020 in the Pubmed database. Nineteen clinical studies from 2005 to 2019 that focused on ePTFE-based valves were summarized. The evolution of the ePTFE-based valve over 3 decades and recent relevant in vitro studies were investigated. RESULTS The average freedom from reintervention or surgery in the recorded ePTFE-based valve population was 90.2% at 5 years, and the survival rate was 96.7% at 3 years. CONCLUSIONS Non-inferior clinical results of this ePTFE handmade valve were revealed compared to allograft or xenograft options for pulmonary valve replacement. Future investigations on transferring ePTFE trileaflet design to transcatheter devices should be considered.
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Affiliation(s)
- Te-I Chang
- Division of Cardiovascular Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.,Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan
| | - Kang-Hong Hsu
- Division of Cardiovascular Surgery, Department of Surgery, Mackay Memorial Hospital, Taipei, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Shao-Jung Li
- Division of Cardiovascular Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.,Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Min-Kai Chuang
- Division of Cardiovascular Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chi-Wen Luo
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yi-Jen Chen
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Division of Cardiovascular Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chung-I Chang
- Division of Cardiovascular Surgery, Department of Surgery, Mackay Memorial Hospital, Taipei, Taiwan
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Right Ventricle to Pulmonary Artery Conduit With Tricuspid Expanded Polytetrafluoroethylene Valves. Ann Thorac Surg 2020; 112:831-837. [PMID: 32946840 DOI: 10.1016/j.athoracsur.2020.06.119] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 06/06/2020] [Accepted: 06/29/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Excellent outcomes of right ventricle to pulmonary artery conduits with expanded polytetrafluoroethylene (ePTFE) valves have been reported. The purpose of this study was to evaluate the outcomes of the different material conduits with tricuspid ePTFE valves. METHODS Forty-one consecutive patients who received right ventricle to pulmonary artery conduit with tricuspid ePTFE valves for biventricular repair between April 2004 and December 2016 were studied. The conduits made of autologous pericardial roll or xenograft roll were used in 22 patients (group P) and the conduits made of ePTFE tube were used in 19 patients (group G). The conduit reoperation and the conduit dysfunction were analyzed. RESULTS During the median follow-up of 5.8 years, no death related to the conduit was observed. There were four reoperations (three in group P and one in group G). Freedom from conduit reoperation at 5 years was 100% in both groups (P = .30). Freedom from more than moderate conduit stenosis at 5 years after operation was not significantly different between groups (46.9% in group P vs 76.3% in group G, P = .23) even though the group G conduits were significantly smaller and freedom from more than moderate conduit regurgitation at 5 years was significantly better in group G (63.3% in group P vs 94.1% in group G, P = .04). CONCLUSIONS The conduit with ePTFE valves in the ePTFE tubes had better conduit function compared with the conduit with autologous pericardial or xenograft roll, especially in terms of conduit regurgitation.
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Zhu G, Wei Y, Yuan Q, Cai L, Nakao M, Yeo JH. In vitro Assessment of the Impacts of Leaflet Design on the Hemodynamic Characteristics of ePTFE Pulmonary Prosthetic Valves. Front Bioeng Biotechnol 2020; 7:477. [PMID: 32076599 PMCID: PMC7006451 DOI: 10.3389/fbioe.2019.00477] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 12/23/2019] [Indexed: 12/04/2022] Open
Abstract
Prosthetic pulmonary valves are widely used in the management procedures of various congenital heart diseases, including the surgical pulmonary valve replacement (PVR) and right ventricular outflow tract reconstruction (RVOT). The discouraging long-term outcomes of standard prostheses, including homografts and bioprosthetic, constrained their indications. Recent developments in the expanded-polytetrafluoroethylene (ePTFE) pulmonary prosthetic valves provide promising alternatives. In this study, the hemodynamic characteristics of bileaflet and trileaflet ePTFE valve designs were experimentally evaluated. The in vitro tests were performed under the right ventricle (RV) flow conditions by using an in vitro RV circulatory system and particle image velocimetry (PIV). The leaflet kinetics, trans-valvular pressure gradients, effective orifice areas, regurgitant fractions, energy losses, velocity fields, and Reynolds shear stress (RSS) in both prostheses were evaluated. The opening of the bileaflet and trileaflet valve takes 0.060 and 0.088 s, respectively. The closing of the former takes 0.140 s, in contrast to 0.176 s of the latter. The trans-valvular pressure is 6.8 mmHg in the bileaflet valve vs. 7.9 mmHg in the trileaflet valve. The effective orifice area is 1.83 cm2 in the bileaflet valve and 1.72 cm2 in the trileaflet valve. The regurgitant fraction and energy loss of bileaflet are 7.13% and 82 mJ, which are 7.84% and 101.64 mJ in its bileaflet counterpart. The maximum RSS of 48.0 and 49.2 Pa occur at the systole peak in the bileaflet and trileaflet valve, respectively. A higher average RSS level is found in the bileaflet valve. The results from this preliminary study indicate that the current bileaflet prosthetic valve design is capable of providing a better overall hemodynamic performance than the trileaflet design.
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Affiliation(s)
- Guangyu Zhu
- School of Energy and Power Engineering, Xi'an Jiaotong University, Xi'an, China
| | - Yuan Wei
- School of Energy and Power Engineering, Xi'an Jiaotong University, Xi'an, China
| | - Qi Yuan
- School of Energy and Power Engineering, Xi'an Jiaotong University, Xi'an, China
| | - Li Cai
- NPU-UoG International Cooperative Lab for Computation and Application in Cardiology, Northwestern Polytechnical University, Xi'an, China
| | - Masakazu Nakao
- Cardiothoracic Surgery, KK Women's and Children's Hospital, Singapore, Singapore
| | - Joon Hock Yeo
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore, Singapore
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Yamamoto Y, Yamagishi M, Maeda Y, Asada S, Hongu H, Fujita S, Yaku H. Histopathologic Analysis of Explanted Polytetrafluoroethylene-Valved Pulmonary Conduits. Semin Thorac Cardiovasc Surg 2019; 32:990-999. [PMID: 31606427 DOI: 10.1053/j.semtcvs.2019.10.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 10/02/2019] [Indexed: 11/11/2022]
Abstract
The expanded polytetrafluoroethylene (ePTFE)-valved conduits as alternative material for right ventricular outflow reconstruction provides satisfactory long-term outcomes. The purpose of this study was to investigate degenerative changes in failed conduits through histopathologic analysis of the explanted specimens. All leaflets of explanted conduits were observed macroscopically, and their longitudinal sections were examined microscopically. Three typical findings, that is, calcification of the leaflet, neointimal proliferation, and proteinaceous infiltration into the leaflet, were evaluated quantitatively by measuring their degree and appearance probability. A total of 15 leaflets from 5 failed conduits (group F) and 12 leaflets from 5 nonfailed conduits (group non-F) were included. The median duration of implantation was 7.6 years (5.3-10.9 years) in group F and 1.3 years (0.7-3.9 years) in group non-F (P = 0.003). In group F, calcification tended to occur in the middle and upper third of the leaflet, causing stiffening, distortion, and exophytic concretion of the leaflet, and mean neointimal thickness on inflow and outflow surfaces were 0.33 ± 0.02 mm and 0.22 ± 0.01 mm, respectively. There was a moderately strong correlation between appearance probability of calcification in group F and that of proteinaceous infiltration in group non-F (correlation coefficient 0.67, P < 0.001). Proteinaceous infiltration into the leaflet was presumed be responsible for future calcification of the leaflet and subsequent stenotic conduit failure. Modification of the ePTFE material to prevent proteinaceous infiltration may contribute to improving the durability of ePTFE-valved conduit.
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Affiliation(s)
- Yusuke Yamamoto
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, Japan.
| | - Masaaki Yamagishi
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, Japan
| | - Yoshinobu Maeda
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, Japan
| | - Satoshi Asada
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, Japan
| | - Hisayuki Hongu
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, Japan
| | - Shuhei Fujita
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, Japan
| | - Hitoshi Yaku
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, Japan
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12
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Si MS. Expanded polytetrafluoroethylene right ventricle to pulmonary artery conduit: Time to adopt? J Thorac Cardiovasc Surg 2018; 156:1637-1638. [PMID: 29908697 DOI: 10.1016/j.jtcvs.2018.05.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 05/07/2018] [Accepted: 05/08/2018] [Indexed: 11/17/2022]
Affiliation(s)
- Ming-Sing Si
- Section of Pediatric Cardiovascular Surgery, Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich.
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