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Published on: June 8, 2022
Long-Term Outcomes With Expanded Polytetrafluoroethylene Valved Conduits in Pediatric Patients
Yoshio Ootaki1, Ashok Muralidaran1, Inder Mehta2
1Oregon Health & Science University, Portland, Oregon.
Insights
This study shows expanded polytetrafluoroethylene valved conduits (ePTFE VC) offer excellent long-term outcomes for pulmonary valve replacement (PVR). These conduits provide a landing zone for transcatheter PVR when needed, with 90% freedom from it at 10 years.
Area of Science:
- Cardiovascular Surgery
- Biomaterials Science
- Pediatric Cardiology
Background:
- Expanded polytetrafluoroethylene (ePTFE) valved conduits (VC) are utilized for pulmonary valve replacement (PVR).
- Long-term outcomes of a specific trileaflet ePTFE VC design were investigated.
Purpose of the Study:
- To review the long-term clinical performance and outcomes of a trileaflet ePTFE valved conduit used for pulmonary valve replacement.
Main Methods:
- A multicenter study involving patients who received ePTFE VCs between 2012 and 2023.
- Valve function was assessed via echocardiography during surgery and follow-up visits.
- Clinical follow-up data was collected for an average of 3.6 years.
Main Results:
- Fifty-five patients (age 6 months to 20 years) received ePTFE VCs (16-28 mm diameter).
- No hospital deaths or endocarditis occurred; 90% freedom from transcatheter PVR (TPVR) at 10 years.
- No explantation or surgical replacement of the ePTFE VCs was required.
Conclusions:
- The ePTFE VC demonstrates excellent long-term performance compared to historical PVR options.
- It serves as an accessible landing zone for subsequent TPVR if necessary.
- The technique is reproducible and valuable for pediatric pulmonary valve replacement.
Background:
The expanded polytetrafluoroethylene (ePTFE) valved conduit (VC) has been reported for pulmonary valve replacement (PVR). The purpose of this study was to review long-term outcomes of our trileaflet ePTFE VC.
Methods:
This multicenter study was performed with institutional review board approval from each institution. Our VC is fashioned from commercially available ePTFE tube grafts (for the conduit) and 0.1-mm-thick ePTFE membrane (for the trileaflet material). The patients were followed up in our clinic. Valve function was assessed by echocardiography in the operating room and at follow-up clinic visits after implantation.
Results:
Fifty-five patients received ePTFE VC between 2012 and 2023 (16-28 mm in diameter). Patients' age at the time of implantation ranged from 6 months to 20 years (median, 7.5 years). Clinical follow-up ranged from 4 days to 10.1 years (average, 3.6 years). There were no hospital deaths. There were 2 non-valve-related late deaths. There have been no cases of endocarditis. Two patients required balloon dilation for the distal pulmonary artery stenosis, and 1 patient required residual ventricular septal defect closure. Five patients have received transcatheter PVR (TPVR) because of increased pressure gradient across the VC. Freedom from TPVR at 10 years was 90%. No valves required explantation or surgical replacement.
Conclusions:
Compared with historical data for other PVR options, our ePTFE VC shows excellent long-term performance and, when required, provides an easily accessible "landing zone" for TPVR. Our technique is easily learned, is reproducible, and can be a valuable option for surgeons performing PVR in pediatric patients.
