[I-AEPCJS-02] Results of expanded polytetrafluoroethylene conduits with bulging sinuses and a fan-shaped valve in right ventricular outflow tract reconstruction
キーワード：RVOT reconstruction, valved conduit, TOF
Objective: We developed a handmade expanded polytetrafluoroethylene (ePTFE) pulmonary valvular conduit (PVC) with bulging sinuses and a fan-shaped ePTFE valve for right ventricular outflow tract (RVOT) reconstruction. We aimed to investigate the results of our PVC in this multicenter study.
Methods: From 2001, 1776 patients underwent RVOT reconstruction using ePTFE PVCs in the definitive repair at 65 institutions in Japan. A total of 1619 patients (91.2%) underwent Rastelli-type procedures, and 146 patients (8.2%) underwent Ross procedure. The median age/body weight were 4.1 years/13.3 kg, respectively. The median PVC size was 18mm. The median Z-value of the PVC was 1.1 (range, -3.8 to 5.0).
Results: The median follow-up period was 3.3 years (max 16.2 years). There were only 9 cases (0.5%) with PVC-related deaths (sudden:4, unknown:5). Re-intervention was performed in 283 patients (15.9%), and 190 patients (10.7%) required explantation. Freedom from re-intervention and explantation at 5/10 years were 86.7/61.5% and 93.0/69.1%, respectively. At the latest echocardiography, PVC regurgitation grade was better than mild in 88.4%. The average peak RVOT gradient was 15.7±15.9 mmHg. ePTFE PVC infection was detected in only 8 patients (0.5%). Relative stenosis due to somatic growth was the most common cause of PVC explantation.
Conclusion: The performance of ePTFE in terms of durability, valvular performance, and the resistance against infection is considerable and may replace conventional prosthetic materials. Large-sized PVC could almost completely avoid the re-intervention.
Methods: From 2001, 1776 patients underwent RVOT reconstruction using ePTFE PVCs in the definitive repair at 65 institutions in Japan. A total of 1619 patients (91.2%) underwent Rastelli-type procedures, and 146 patients (8.2%) underwent Ross procedure. The median age/body weight were 4.1 years/13.3 kg, respectively. The median PVC size was 18mm. The median Z-value of the PVC was 1.1 (range, -3.8 to 5.0).
Results: The median follow-up period was 3.3 years (max 16.2 years). There were only 9 cases (0.5%) with PVC-related deaths (sudden:4, unknown:5). Re-intervention was performed in 283 patients (15.9%), and 190 patients (10.7%) required explantation. Freedom from re-intervention and explantation at 5/10 years were 86.7/61.5% and 93.0/69.1%, respectively. At the latest echocardiography, PVC regurgitation grade was better than mild in 88.4%. The average peak RVOT gradient was 15.7±15.9 mmHg. ePTFE PVC infection was detected in only 8 patients (0.5%). Relative stenosis due to somatic growth was the most common cause of PVC explantation.
Conclusion: The performance of ePTFE in terms of durability, valvular performance, and the resistance against infection is considerable and may replace conventional prosthetic materials. Large-sized PVC could almost completely avoid the re-intervention.