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Ten-year Experience With Hand-made Trileaflet Polytetrafluoroethylene Valved Conduit Used For Pulmonary Reconstruction
M. Ando, T. Sasaki, Y. Takahashi. Sakakibara Heart Institute, Tokyo, Japan,
BACKGROUND:
Homograft is routinely used for reconstruction of pulmonary artery in congenital heart surgery. However it is not always available, and xenograft or other synthetic conduits have been used as alternatives. Polytetrafluoroethylene (PTFE) is chemically inert, has low friction, and possesses low tissue affinity. Therefore, it is theoretically resistant to degeneration or calcification, and is a useful substitute for the pulmonary valve. Following disappointing results with xenograft, we have used Dacron conduit incorporating trileaflet PTFE valve for pulmonary reconstruction since 1997.
METHODS:
A 0.1mm PTFE membrane was folded leaving a few millimeters margin. It was separated by suture lines to create three pockets. It was then rolled and sutured inside the conduit. Hence, a Dacron conduit integrating three sinuses and valves comprising PTFE membrane was created. One hundred and thirty four patients underwent pulmonary reconstruction using PTFE conduit, including reoperation after previous repair in 61 patients. There were 51 females. Mean age and body weight were 12.9±12.0 (0.07-62.5) years and 30.7±19.7 (3.4-101) kg. Mean size of the conduit was 21.1±3.7 (12-28) mm. Z-score of the conduit was +0.4±0.8 for patients >15years (n=42), +1.1±0.7 for 5-15 years (n=47), and +2.4±0.5 for <5 years (n=45). Conduit was used for Ross procedure in 21 patients, and for repair of complex congenital heart disease in 113. Twenty one of them had transposition of the great arteries. Results were compared with those of xenograft valved conduits (including handmade xenograft pericardial conduit in 23, Carpentier-Edwards valved conduit in 5, and Hancock valved conduit in 4) implanted between 1987 and 1997. Mean age and size of the conduit were 11.6±3.1 (5.6-18.6) years and 20.9±1.8 (18-25) mm in this reference group.
RESULTS:
There were two in-hospital deaths (1.5%) and one late death. The conduit was explanted on three occasions due to pulmonary artery distortion at the distal conduit-to-pulmonary artery anastomosis (interval=1.2 years), pulmonary artery distortion with kinking of the conduit (4.9 years), and extrinsic compression by the aortic pseudoaneurysm after Ross procedure (5.4 years). Freedom from reoperation was 89.1±6.8% (xenograft=74.8±7.7%) at 10 years. PTFE conduit had a superior functional durability compared with xenograft, according to evaluation of conduit stenosis and pulmonary insufficiency by Doppler echocardiogram (Figure). All valves maintained their motion, whereas calcific fixation of the valve was identified after 3 years in the xenograft group. Pulmonary insufficiency was ≤ mild in 66.7% at 10 years. Progression of conduit stenosis in the first 5 years was 9.0±10.3 mmHg for PTFE conduit and 17.6±18.4 mmHg for xenograft (p=0.098). There was no structural deterioration of the PTFE membrane, cellular infiltration, or calcification noted on electron microscopy in the explanted specimen.
CONCLUSIONS:
PTFE valved conduit had a superior functional durability to xenograft, and maintained its valve motion up to 10 years in all patients. There was no reoperation due to structural deterioration during this time period. PTFE conduit is a reliable alternative to homograft for pulmonary reconstruction. 
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