Right Ventricular Outflow Tract Reconstruction With a Polytetrafluoroethylene Monocusp Valve: A 20-Year Experience

In patients with tetralogy of Fallot (TOF), pulmonary atresia (PA), and other congenital right ventricular outflow tract (RVOT) malformations, polytetrafluoroethylene (PTFE) monocusp outflow tract patches (MOTP) relieve obstruction and provide pulmonary valve competence. The purpose of this study wa...

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Bibliographic Details
Published in:Seminars in thoracic and cardiovascular surgery 2016, Vol.28 (2), p.463-470
Main Authors: Kumar, Mohineesh, MD, Turrentine, Mark W., MD, Rodefeld, Mark D., MD, Bell, Teresa, PhD, Brown, John W., MD
Format: Article
Language:English
Subjects:
Cardiothoracic Surgery
Child
Child, Preschool
Echocardiography, Doppler
Female
Gore-tex Monocusp
Heart Septal Defects - diagnostic imaging
Heart Septal Defects - mortality
Heart Septal Defects - physiopathology
Heart Septal Defects - surgery
Heart Valve Prosthesis
Heart Valve Prosthesis Implantation - adverse effects
Heart Valve Prosthesis Implantation - instrumentation
Heart Valve Prosthesis Implantation - mortality
Humans
Infant
Kaplan-Meier Estimate
Left-Systole
Magnetic Resonance Imaging
Male
Polytetrafluoroethylene
Prosthesis Design
Prosthesis Failure
Pulmonary Atresia - diagnostic imaging
Pulmonary Atresia - mortality
Pulmonary Atresia - physiopathology
Pulmonary Atresia - surgery
Pulmonary Valve - diagnostic imaging
Pulmonary Valve - physiopathology
Pulmonary Valve - surgery
Pulmonary Valve Insufficiency - diagnostic imaging
Pulmonary Valve Insufficiency - mortality
Pulmonary Valve Insufficiency - physiopathology
Pulmonary Valve Insufficiency - surgery
Reoperation
Retrospective Studies
Right-Diastole
Risk Factors
Stroke Volume
Tetralogy of Fallot - diagnostic imaging
Tetralogy of Fallot - mortality
Tetralogy of Fallot - physiopathology
Tetralogy of Fallot - surgery
Time Factors
Treatment Outcome
Ventricular Function, Left
Ventricular Function, Right
Ventricular Outflow Obstruction - diagnostic imaging
Ventricular Outflow Obstruction - mortality
Ventricular Outflow Obstruction - physiopathology
Ventricular Outflow Obstruction - surgery
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Summary:In patients with tetralogy of Fallot (TOF), pulmonary atresia (PA), and other congenital right ventricular outflow tract (RVOT) malformations, polytetrafluoroethylene (PTFE) monocusp outflow tract patches (MOTP) relieve obstruction and provide pulmonary valve competence. The purpose of this study was to determine whether our PTFE-MOTP was an acceptable short- and mid-term remedy for patients with TOF or PA as assessed by freedom from severe pulmonary regurgitation and freedom from reoperation. From 1994-2014, 171 patients (mean age 1.5 ± 1.5 years; median 1.1 years) with TOF or PA underwent initial right ventricular outflow tract (RVOT) reconstruction with a PTFE-MOTP. Patients were studied intraoperatively and serially postoperatively using echocardiography and cardiac magnetic resonance imaging (CMR) to determine pulmonary valve dysfunction defined as a peak gradient >40 mm Hg or valve regurgitation>moderate. The mean follow-up duration was 10.9 ± 5.8 years (range: 1 month-20 years). There were 5 late deaths and 1 early death. There was a significant difference between the preoperative and postoperative peak RVOT gradients (74.0 vs 25.2 mm Hg). Of the 171 patients, 25 were lost to follow-up, and 42 have required replacement of their monocusp valves 10.1 ± 5.0 years (range: 5 months-19 years) after original monocusp insertion. At 10-year follow-up, severe pulmonary regurgitation was seen in less than 25% of patients, and severe pulmonary stenosis was seen in less than 10% of patients. Since 2007, CMR was used in 44 patients to characterize cardiac function in patients under consideration for PTFE-MOTP replacement. The average right ventricular-to-left ventricular (RV/LV) ratio on CMR was 1.7 ± 0.5 in these patients. CMR also showed that RV ejection fraction (52 ± 9%) and left ventricular ejection fraction (58 ± 7%) were both preserved in most patients. The PTFE-MOTP is an excellent short-term and mid-term option for initial RVOT reconstruction, particularly in children with TOF with nonsalvageable pulmonary valve or PA-ventricular septal defect.
ISSN:1043-0679
1532-9488
DOI:10.1053/j.semtcvs.2016.05.003