JTCS Sign the Guestbook
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
John W. Brown
Mark Ruzmetov
Palaniswamy Vijay
Mark D. Rodefeld
Mark W. Turrentine
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Brown, J. W.
Right arrow Articles by Turrentine, M. W.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Brown, J. W.
Right arrow Articles by Turrentine, M. W.
Related Collections
Right arrow Valve disease
Right arrowRelated Article

J Thorac Cardiovasc Surg 2007;133:1336-1343
© 2007 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease

Right ventricular outflow tract reconstruction with a polytetrafluoroethylene monocusp valve: A twelve-year experience

John W. Brown, MD1,*, Mark Ruzmetov, MD, PhD, Palaniswamy Vijay, PhD, MPH, Mark D. Rodefeld, MD, Mark W. Turrentine, MD

Section of Cardiothoracic Surgery, James Whitcomb Riley Hospital for Children and Indiana University School of Medicine, Indianapolis, Ind.

Read at the Thirty-second Annual Meeting of the Western Thoracic Surgical Association, Sun Valley, Idaho, June 21-24, 2006.

Received for publication July 7, 2006; revisions received December 15, 2006; accepted for publication December 18, 2006.

* Address for reprints: John W. Brown, MD, Section of Cardiothoracic Surgery, Indiana University School of Medicine, 545 Barnhill Dr., EH 215, Indianapolis, IN, 46202-5123. (Email: jobrown{at}iupui.edu).

Objective: Transannular patching of the right ventricular outflow tract results in pulmonary insufficiency. Biologic monocusp valves prevent early pulmonary insufficiency but usually become nonfunctional in less than 1 year. Polytetrafluoroethylene monocusp leaflets demonstrated favorable characteristics in our animal studies and have been applied to a variety of right ventricular outflow tract reconstructions at our institution.

Methods: From 1994 through 2006, 192 patients (mean age, 3.3 ± 5.0 years) underwent right ventricular outflow tract reconstruction with a polytetrafluoroethylene monocusp valve (192 patients; 202 implants). Intraoperative, early postoperative, and late follow-up echocardiographic data (mean interval, 4.9 ± 3.1 years; range, 6 months to 12 years) were retrospectively obtained to compare clinical outcomes among three preoperative diagnostic groups: patients undergoing initial repair of tetralogy of Fallot or pulmonary atresia/ventricular septal defect (group I), patients undergoing redo right ventricular outflow tract procedures (group II), and patients undergoing complex initial repairs (group III).

Results: There were 4 early and 5 late deaths (9/192; 5%). The difference between the preoperative and postoperative peak right ventricular outflow tract gradients was significant (71.2 vs 23.1; P < .0001). Twenty-five (14%) patients had mild-to-moderate right ventricular outflow tract stenosis at one or more locations proximal and/or distal to the monocusp patch (mean gradient, 44.7 ± 20.3 mm Hg). Freedom from increased pulmonary insufficiency greater than moderate was 86% at 1 year, 68% at 5 years, and 48% at 10 years. Twenty-five patients have undergone 35 reoperations 4.2 ± 3.1 years (range, 3 months to 10 years after initial repair). Kaplan–Meier freedom from reoperation was 96%, 89%, and 82% at 1, 5, and 10 years. Freedom from reoperation in group II (69%) was significantly different from group I (88%; P = .01) and from group III (90%; P = .02), but there was no difference between groups I and III.

Conclusions: Use of a polytetrafluoroethylene monocusp valve prevents early and significantly reduces midterm pulmonary insufficiency. It is relatively inexpensive, easy to construct, and remains free from significant stenosis in the majority of patients. We have not witnessed significant calcification or pulmonary embolization, and the only antithrombic agent used has been low-dose aspirin.

Abbreviations and Acronyms LV = left ventricle; PA = pulmonary artery; PI = pulmonary insufficiency; PTFE = polytetrafluoroethylene; RV = right ventricle(ular); RVOT = right ventricular outflow tract; TOF = tetralogy of Fallot; VSD = ventricular septal defect


Related Article

Discussion
J. Thorac. Cardiovasc. Surg. 2007 133: 1342-1343. [Extract] [Full Text] [PDF]





HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
ANN THORAC SURG ASIAN CARDIOVASC THORAC ANN EUR J CARDIOTHORAC SURG
J THORAC CARDIOVASC SURG ICVTS ALL CTSNet JOURNALS
Copyright © 2007 by The American Association for Thoracic Surgery.