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Polytetrafluoroethylene bicuspid pulmonary valve implantation: experience with 126 patients
James Anthony Quintessenza1, Jeffrey Phillip Jacobs, Paul Jubeong Chai
1Congenital Heart Institute of Florida, All Children's Hospital and Children's Hospital of Tampa, University of South Florida College of Medicine, Cardiac Surgical Associates of Florida, Saint Petersburg and Tampa, FL, USA.
Insights
Surgically created bicuspid pulmonary valves using polytetrafluoroethylene (PTFE) show safe and effective intermediate-term results. Thinner PTFE material may improve durability and function for patients with pulmonary valve issues.
Area of Science:
- Cardiovascular Surgery
- Biomaterials Science
- Congenital Heart Disease
Background:
- Congenital heart defects often require surgical intervention, including pulmonary valve replacement.
- Polytetrafluoroethylene (PTFE) has been explored as a material for constructing prosthetic valves.
- Previous bicuspid pulmonary valve reconstructions faced challenges with leaflet mobility and calcification.
Purpose of the Study:
- To report initial outcomes of surgically created bicuspid pulmonary valves using PTFE.
- To evaluate the safety and efficacy of PTFE bicuspid pulmonary valves in a diverse patient population.
- To compare outcomes between different thicknesses of PTFE material used for valve construction.
Main Methods:
- A cohort of 126 patients received surgically created PTFE bicuspid pulmonary valves.
- Valves were implanted in the right ventricular outflow tract for conditions like pulmonary insufficiency or stenosis.
- Patients were divided into two groups based on PTFE material thickness (0.6-mm vs. 0.1-mm).
- Follow-up included clinical assessment and echocardiography for up to 8.3 years.
Main Results:
- Low operative (0.8%) and late (2.4%) mortality rates were observed.
- Six patients (4.8%) required valve replacement, all initially receiving 0.6-mm porous PTFE valves.
- Valves constructed from thinner, nonporous 0.1-mm PTFE demonstrated improved leaflet mobility and lower gradients.
- Intermediate-term follow-up indicates acceptable performance and safety.
Conclusions:
- Surgically created PTFE bicuspid pulmonary valves are safe and effective for intermediate-term use.
- Thinner (0.1-mm) nonporous PTFE material appears to enhance valve function and durability.
- Long-term studies are needed to fully ascertain the lasting value of this technique.
Abstract:
This article reports our initial experience in 126 consecutive patients treated with placement of a surgically created polytetrafluoroethylene (PTFE) bicuspid pulmonary valve at The Congenital Heart Institute of Florida (CHIF). A bicuspid pulmonary valve is created with PTFE and sutured into the right ventricular outflow tract. PTFE bicuspid pulmonary valves were placed in 126 patients (age: range, 3.1-64.7 years, mean, 17.9 years; weight: range, 14.2-113.6 kg, mean, 55.4 kg). All patients had pulmonary insufficiency, pulmonary stenosis, or both, most commonly after previous repair of tetralogy of Fallot (71 patients). Follow-up was up to 8.3 years (range, 0-8.3 years, mean, 3.34 years). Operative mortality was 1 patient (0.8%). Late mortality was non-valve-related in 3 patients (2.4%). The initial 84 patents in this series received valves constructed from PTFE with 0.6-mm thickness. The next 42 patients received valves constructed from PTFE with 0.1-mm thickness. Six patients of 126 (4.8%) required replacement of the PTFE bicuspid pulmonary valve because of immobile and calcified leaflets. All 6 who required replacement of the PTFE bicuspid pulmonary valve initially received a valve constructed from porous 0.6-mm PTFE material. We currently use nonporous 0.1-mm PTFE, which does not allow cellular in-growth and thickening. Early echocardiographic follow-up of these valve leaflets made with 0.1-mm PTFE has demonstrated improved leaflet mobility and pliability and lower transvalvar gradients. PTFE bicuspid pulmonary valve implantation is safe and effective and demonstrates acceptable performance for the intermediate term. It is anticipated that using thinner 0.1-mm PTFE will improve valve function and durability. Long-term follow-up is necessary to determine the true value of this technique.
