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, 510080, 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 ventricle outflow tract reconstruction; pulmonary regurgitation; polytetrafluoroethylene; valved conduit; congenital heart diseases

DOI：

10.7507/1007-4848.202306050

Video：

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Objective To modify the sewing technique of a hand-made bicuspid pulmonary valve using the expanded polytetrafluoroethylene in right ventricle outflow tract reconstruction for summarizing the short-term experience. Methods The patients with complex congenital heart diseases and concurrent contaminant pulmonary regurgitation that underwent right ventricle outflow tract reconstruction through the bicuspid pulmonary valve were enrolled. The postoperative artificial valve function and right ventricle function indexes were evaluated. Results A total of 17 patients were collected, including 10 males and 7 females, with an average age of 18.18 years and an average weight of 40.94 kg. Of 17 patients, 16 used valved conduit for the reconstruction of the right ventricle outflow tract with the size ranging from 18 to 24 mm. There was no patient requiring mechanical circulatory support and no in-hospital death. During the follow-up with a mean period of 12.89 months, only one vale dysfunction occurred without any complications and adverse events (P<0.001). Postoperative right atrium diameter, right ventricle diameter, and tricuspid regurgitation area significantly decreased in contrast to those preoperatively (P<0.05). Conclusion Sewing the bicuspid pulmonary valve utilizing 0.1 mm expanded polytetrafluoroethylene is a feasible, effective, and safe technique of right ventricle outflow tract reconstruction in the field of complex congenital heart diseases.

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, Autumn,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.	Liu XG, Wu KH, Shi C, et al. The clinical results of right ventricular outflow tract reconstruction with a transannular patch of autologous pericardium. Zhonghua Yi Xue Za Zhi. 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, Autumn,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. Liu XG, Wu KH, Shi C, et al. The clinical results of right ventricular outflow tract reconstruction with a transannular patch of autologous pericardium. Zhonghua Yi Xue Za Zhi. 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

Latest ArticlesApplication of bicuspid pulmonary valve sewn by 0.1 mm expanded polytetrafluoroethylene in right ventricle outflow tract reconstruction

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