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Right Ventricular Outflow Tract Reconstruction with a PTFE Monocusp: A 10-Year Experience
J. W. Brown*, M. Ruzmetov, P. Vijay, M. D. Rodefeld*, M. W. Turrentine. Indiana University School of Medicine, Indianapolis, IN,
BACKGROUND: Transannular patching of right ventricular outflow tract (RVOT) results in pulmonary insufficiency(PI). Biologic monocusp valves(MO) can prevent acute PI but are prone to early dysfunction and progressive regurgitation. Polytetrafluoroethylene(PTFE) MO leaflets demonstrated favorable characteristics in animal studies and have been applied to a variety of RVOT anomalies at our Center.
METHODS: From 1994 through August 2005, 190 patients underwent PTFE MO RVOT reconstruction (n=190patients;199 implants) at our institution. Intraoperative, postoperative, and follow-up echocardiographic data at a mean interval of 4.4years (range; 1month to 10years) was used in a retrospective fashion to compare clinical outcomes among preoperative diagnostic groups. In addition, PTFE monocusp valves beyond 6 months post-implant underwent echocardiographic analysis of MO function.
RESULTS: There were 8early (4%) and no late deaths. The mean length of stay was 9.1days, and in ICU stay was 5.8days. The difference between the preoperative and postoperative peak RVOT gradient was significant (71.0 vs 25.2;p=0.0001). 23patients (15%) had mild to moderate supravalvar stenosis (mean gradient,44.2+17.2 mmHg) at the distal anastomosis. MO regurgitation was considered as mild in 49% of patients, moderate in 49% of patients, and severe in 2%. 23patients underwent reoperation (n=24) with the mean time interval 3.7+2.6 years (range; 3 months to 9years). Kaplan-Meier freedom from reoperations was 97% at 1 year, 92% at 5 years, and 87% at 10 years.
CONCLUSIONS: Utilization of a PTFE MO valve prevents short-term and significantly reduces mid-term PI. It is inexpensive, easy to construct, and demonstrates no evidence of late stenosis, calcification, or embolization.
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