Polytetrafluoroethylene Bicuspid Pulmonary Valve Implantation: Experience With 126 Patients

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.

Keywords

tetralogy of Fallot pulmonary stenosis pulmonary insufficiency database congenital heart disease outcomes cardiac surgery results of treatment

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References

Quintessenza

Jacobs

Chai

Morell

Giroud

Boucek

. Late replacement of the pulmonary valve: when and what type of valve? Cardiol Young. 2005;15(suppl 1):58–63.

Quintessenza

Jacobs

Morell

Giroud

Boucek

. The initial experience with a bicuspid polytetrafluoroethylene pulmonary valve in 41 children and adults: a new option for right ventricular outflow tract reconstruction. Ann Thorac Surg. 2005;79:924–931.

Quintessenza

. Polytetrafluoroethylene Bicuspid Pulmonary Valve Implantation. Operative Techniques in Thoracic and Cardiovascular Surgery: A Comparative Atlas. Winter 2008;13(4):244–249.

Jacobs

Mavroudis

Jacobs

. What is operative mortality? Defining death in a surgical registry database: a report from the STS Congenital Database Task Force and the Joint EACTS-STS Congenital Database Committee. Ann Thorac Surg. 2006;81:1937–1941.

Jacobs

, ed. 2008 Supplement to Cardiology in the Young: databases and the assessment of complications associated with the treatment of patients with congenital cardiac disease, prepared by the Multi-Societal Database Committee for Pediatric and Congenital Heart Disease. Cardiol Young. 2008;18(suppl S2):1–530.

Jacobs

. Introduction. Cardiol Young. 2008;18(suppl S2):1–37.

Jacobs

Mavroudis

. Nomenclature and databases for the surgical treatment of congenital cardiac disease—an updated primer and an analysis of opportunities for improvement. Cardiol Young. 2008;18(suppl S2):1–62.

Dearani

Mavroudis

Quintessenza

. Surgical advances in the treatment of adults with congenital heart disease [published online ahead of print September 9, 2009]. Curr Opin Pediatr. 2009;21:565–572.

Dearani

Connolly

Martinez

Fontanet

Webb

. Caring for adults with congenital cardiac disease: successes and challenges for 2007 and beyond. Cardiol Young. 2007;17(suppl 2):87–96.

10.

Brown

Ruzmetov

Vijay

: Right ventricular outflow tract reconstruction with a polytetrafluoroethylene monocusp valve: a twelve year experience. J Thorac Cardiovasc Surg. 2007;133:1336–1343.

11.

Kaushal

Jacobs

Gossett

. Innovation in basic science: stem cells and their role in the treatment of paediatric cardiac failure—opportunities and challenges. Cardiol Young. 2009;19(suppl S2):74–84.