Expanded polytetrafluoroethylene monocuspid valve for right ventricular outflow tract reconstruction

J, Iemura; Oku, Hirosuke; Otaki, M; Kitayama, Hitoshi

doi:10.1016/s0003-4975(00)01841-5

Cited by 20 publications

(17 citation statements)

References 11 publications

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“…Iemura et al emphasized the advantages of ePTFE for RVOT reconstruction; on the other hand, they also reported a case of deterioration of ePTFE applied on the RVOT, which resulted in RV failure and ultimately death. 28 In the present series, 3 patients developed stenosis, and one them underwent homograft replacement. Two patients died, one of which was an early death, and the other, a late death.…”

Section: Discussionmentioning

confidence: 52%

“…Among the patients who received an implant made of ePTFE, none developed severe stenosis, but mild to moderate stenosis of 24-50 mmHg-was observed in some cases. Although several comparative studies on the use of ePTFE have emphasized its advantages, 28 animal experiments have reported disadvantages of ePTFE for use in the RVOT (eg, thickening of the ePTFE consisting of collagen fibers and fibroblasts 29 and focal calcification 30 ). Iemura et al emphasized the advantages of ePTFE for RVOT reconstruction; on the other hand, they also reported a case of deterioration of ePTFE applied on the RVOT, which resulted in RV failure and ultimately death.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Right Ventricle to Pulmonary Artery Reconstruction Using a Valved Homograft

Tatebe

Nagakura

Boyle

et al. 2003

Circ J

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Section: Discussionmentioning

confidence: 52%

Section: Discussionmentioning

confidence: 99%

Right Ventricle to Pulmonary Artery Reconstruction Using a Valved Homograft

Tatebe

Nagakura

Boyle

et al. 2003

Circ J

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“…[18] A larger experience, consisting of 115 patients using a PTFE monocusp for RVOT reconstruction, with follow-up from 6 months to 8 years, mean 2.6 years, demonstrated no stenosis, calcification, or embolization. There was, however, significant development of regurgitation graded as moderate to severe after 35 months.…”

Section: Discussionmentioning

confidence: 99%

Early and 1-year outcome and predictors of adverse outcome following monocusp pulmonary valve reconstruction for patients with tetralogy of Fallot: A prospective observational study

et al. 2014

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Background and Objectives:Repair of tetralogy of Fallot (TOF) with monocusp pulmonary valve reconstruction prevents pulmonary regurgitation (PR) for a variable period. Since postoperative outcome is governed by PR and right ventricular function, we sought to assess the severity of pulmonary regurgitation and right ventricular outflow (RVOT) gradient in the immediate postoperative period and at 1 year and attempted to identify the anatomical substrates responsible for adverse outcomes.Methods:The study included 30 patients. Transthoracic echocardiography was performed before surgery, within 5 days of surgery, and 1 year later. Presence and severity of PR, RVOT gradient, and residual branch pulmonary stenosis were assessed. Right ventricular and monocusp valve functions were studied.Results:Median age was 36.5 months (3-444 months). There were no deaths. Pulmonary regurgitation was mild in 18, moderate in 10, and severe in 2 patients immediately following surgery. At 1 year, 10 patients had severe PR and one had significant RVOT gradient. None of the variables like age, presence of supravalvar pulmonary branch stenosis, main pulmonary artery diameter, or mobility of monocusp valve was found to have any significant association with the progression of PR. McGoon index <1.5 showed a trend toward more PR, while patients with more residual RVOT gradient had lesser regurgitation.Conclusions:Repair of TOF with monocusp pulmonary valve reduces immediate postoperative PR. At 1 year, the monocusp valve underwent loss of function in a significant proportion and PR also progressed. This study could not identify any predictors of progression of PR, though patients with McGoon index <1.5 tended to have more PR while those with more outflow gradient had lesser PR.

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“…Because of the shortcoming of homografts and heterografts, we elected to investigate creation of a valve from polytetrafluoroethylene, a non immunologic, non-degenerating, and relatively durable material. [33][34][35][36] Monoleaflet valves made of this material have been used successfully to reconstruct the right ventricular outflow tract. 34,35 Unfortunately, when using only a solitary leaflet, significant pulmonary insufficiency occurs over time as the patients grow.…”

Section: Reconstruction Of the Right Ventricular Outflow Tract Using mentioning

confidence: 99%

“…It was a less than ideal experience with these currently available options that stimulated our interest into employing alternative materials and techniques. Favorable experimental and clinical experience with valves made of a polytetrafluoroethylene monoleaflet [33][34][35][36] encouraged us to consider a new method of reconstruction with this material, using a bifoliate polytetrafluoroethylene valve. In this work, we review our indications for replacement of the pulmonary valve after repair of tetralogy of Fallot, the surgical options available, and our experience reconstructing the right ventricular outflow tract with a new surgically created bifoliate polytetrafluoroethylene valve.…”

mentioning

confidence: 99%

Late replacement of the pulmonary valve: when and what type of valve?

et al. 2005

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patients present in need of reoperative surgical reconstruction of the right ventricular outflow tract. The predominant physiologic lesion is pulmonary insufficiency, but there may also be varying degrees of obstruction of the right ventricular outflow tract. In the past, it has been felt that patients tolerate pulmonary insufficiency reasonably well. In some patients, however, the long-term effects of pulmonary insufficiency and subsequent right ventricular dilation and dysfunction are associated with poor exercise tolerance and increased incidence of arrhythmias and sudden death. 1,2 Numerous studies support replacement of the pulmonary valve as treatment for pulmonary insufficiency in order to improve performance, optimize hemodynamics, and better control arrhythmias. 3-10 The indications for reconstruction of the right ventricular outflow tract in this setting, nonetheless, as well as the operative strategy, continue to evolve. There are multiple surgical options for replacement of the pulmonary valve for these patients, including aortic and pulmonary homografts, stented and stentless porcine valves, porcine valved conduits, bovine jugular venous conduits, and even mechanical valves and mechanical valved conduits. 11-32 It was a less than ideal experience with these currently available options that stimulated our interest into employing alternative materials and techniques. Favorable experimental and clinical experience with valves made of a polytetrafluoroethylene monoleaflet 33-36 encouraged us to consider a new method of reconstruction with this material, using a bifoliate polytetrafluoroethylene valve. In this work, we review our indications for replacement of the pulmonary valve after repair of tetralogy of Fallot, the surgical options available, and our experience reconstructing the right ventricular outflow tract with a new surgically created bifoliate polytetrafluoroethylene valve. Indications for replacement of the pulmonary valveIncreasingly over the last several years, concerns have emerged regarding postoperative pulmonary insufficiency or combined insufficiency and stenosis. It is no longer simply accepted that that pulmonary insufficiency is well tolerated after valvectomy and/or transanular patching during repair of tetralogy of Fallot. The sequence of pulmonary insufficiency causing volume overload leading to right ventricular dilation and dysfunction has been demonstrated with echocardiography and magnetic resonance imaging. Exertional symptoms often follow these objective changes in ventricular function and size, 37 and can be documented with exercise testing. More worryingly, life-threatening ventricular arrhythmias seem to be associated with the more severe cases of pulmonary insufficiency and ventricular changes. 38 Right ventricular dilation and dysfunction, however, has been shown to be reversible following Cardiol Young 2005; 15 (Suppl. 1): 58-63

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Expanded polytetrafluoroethylene monocuspid valve for right ventricular outflow tract reconstruction

Cited by 20 publications

References 11 publications

Right Ventricle to Pulmonary Artery Reconstruction Using a Valved Homograft

Right Ventricle to Pulmonary Artery Reconstruction Using a Valved Homograft

Early and 1-year outcome and predictors of adverse outcome following monocusp pulmonary valve reconstruction for patients with tetralogy of Fallot: A prospective observational study

Late replacement of the pulmonary valve: when and what type of valve?

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