Outcomes of Handmade Tri-leaflet ePTFE Valved Conduits for RVOT Reconstruction: A Propensity-Matched Analysis...

We aimed to evaluate the long-term durability and valve function of handmade expanded polytetrafluoroethylene (ePTFE) valved conduits of different calibers and compare their outcomes with those of bioprosthetic pulmonary valve replacement (PVR). We retrospectively reviewed 100 patients undergoing RVOT reconstruction between 2007 and 2025: 66 with ePTFE conduits and 34 with bioprosthetic valves. Patients were categorized into small-conduit, large-conduit, and PVR groups. Propensity score matching was performed to adjust for baseline differences. Mean age was 1.6 ± 1.8, 11.2 ± 6.5, and 26.3 ± 16.9 years in the small-conduit, large-conduit, and PVR groups, respectively (p < 0.0001). Ten-year survival was similar among groups (100%, 100%, and 97%; p = 0.19). In contrast, the small-conduit group showed significantly lower freedom from RVOT reoperation than the large-conduit and PVR groups (53%, 85%, and 93%; p < 0.001), driven by progressive pulmonary stenosis (10-year freedom from moderate pulmonary stenosis: 9%, 55%, and 58%; p = 0.01). Freedom from moderate pulmonary regurgitation remained comparable (80%, 94%, and 85%; p = 0.37). In the matched cohort, conduit and PVR groups demonstrated similar freedom from reoperation (94% vs. 89%; p = 0.34), with numerically better valve function in the conduit group. In conclusion, large-caliber handmade ePTFE valved conduits demonstrated favorable long-term durability, with outcomes comparable to PVR in adolescent- and adult-sized patients. They may be a reasonable option for selected younger patients requiring redo RVOT reconstruction.