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J Thorac Cardiovasc Surg 2007;134:327-332
© 2007 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease

Expanded polytetrafluoroethylene valved conduit and patch with bulging sinuses in right ventricular outflow tract reconstruction

^a Department of Pediatric Cardiovascular Surgery, Children’s Research Hospital, Kyoto Prefectural University of Medicine, Hirokoji, Kamigyo-ku, Kyoto, Japan
^b Department of Cardiovascular Surgery, Fukuoka Children’s Hospital, Chuo-ku, Fukuoka, Japan.

Received for publication January 14, 2007; revisions received March 13, 2007; accepted for publication March 22, 2007.

^_* Address for reprints: Masaaki Yamagishi, MD, PhD, Department of Pediatric Cardiovascular Surgery, Children’s Research Hospital, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi, Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan. (Email: myama{at}koto.kpu-m.ac.jp).

Objectives: No specific prosthetic material is currently recognized as being the most suitable for right ventricular outflow tract reconstruction for congenital heart defects. Prosthetic valves are subject to wear and stress because they do not create vortex flow, which helps natural valves to close. We designed a fan-shaped expanded polytetrafluoroethylene valved conduit and patch with bulging sinuses that create vortex flow, making them more reliable over the long term.

Methods: Bulging sinuses were formed on a sheet of expanded polytetrafluoroethylene using a specially designed mold. Fan-shaped expanded polytetrafluoroethylene sheets (0.1 mm thick) were anastomosed to the edge of the bulging sinuses as valve leaflets, creating monocuspid, bicuspid, or tricuspid valves. These valves were implanted in 157 patients undergoing right ventricular outflow tract reconstruction (age 16 days to 45.4 years, median 2.0 years), in 48 patients as a conduit, and in 109 patients as a patch. Valve function was followed up by echocardiography for 5.6 to 63.7 months (mean 20.8 months).

Results: There was no mortality or morbidity, and no patients required reoperation during follow-up. No patients had stenosis, and regurgitation was less than mild in all patients with conduits and moderate in 15 patients (13.8%) with patches, but moderate regurgitation did not further develop during follow-up. Valve motion was fully maintained in all patients.

Conclusions: The expanded polytetrafluoroethylene valved conduits and patches with bulging sinuses showed excellent early-to-midterm results. The valved conduits and patches seem to be promising alternatives to homografts in right ventricular outflow tract reconstruction. Their function will be followed up further.

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