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J Thorac Cardiovasc Surg 2009;137:124-131
© 2009 The American Association for Thoracic Surgery

Congenital Heart Disease

Ten-year experience with handmade trileaflet polytetrafluoroethylene valved conduit used for pulmonary reconstruction

Department of Pediatric Cardiac Surgery, Sakakibara Heart Institute, Tokyo, Japan

Received for publication June 16, 2008; revisions received August 11, 2008; accepted for publication August 31, 2008.

^_* Address for reprints: Makoto Ando, MD, Department of Pediatric Cardiac Surgery, Sakakibara Heart Institute, 3-16-1 Asahi-cho, Fuchu-si, Tokyo 183-0003, Japan. (Email: maando{at}shi.heart.or.jp).

Objective: The objective of this study was to investigate the results of handmade polytetrafluoroethylene trileaflet conduits implanted in the pulmonary position since 1997.

Methods: One hundred thirty-nine patients underwent pulmonary reconstruction with a polytetrafluoroethylene conduit. Conduit function was investigated by means of review of serial echocardiographic studies.

Results: Mean age and body weight were 12.7 ± 12.0 years and 30.9 ± 20.6 kg. Mean size of the conduit was 21.0 ± 3.8 mm (12–28 mm). The z score of the conduit was +0.5 ± 0.8 for patients older than 15 years (n = 43), +1.2 ± 0.7 for patients 5 to 15 years old (n = 48), and +2.4 ± 0.5 for patients younger than 5 years (n = 48). Conduits were used for the Ross procedure in 21 patients and for repair of complex congenital heart disease in 118 patients. There were 3 (2.2%) in-hospital deaths and 1 late death. Four patients required conduit explantation because of pulmonary artery distortion at a distal anastomotic site (interval, 1.2 years), infection of the polytetrafluoroethylene valve (interval, 1.6 years), midportion angulation of the conduit (interval, 4.9 years), and conduit compression by the ascending aorta (interval, 5.4 years). Estimated freedom from conduit explantation was 88.0% ± 6.8%, and pulmonary insufficiency was less than or equal to mild in 75.0% at 10 years. All valves maintained their motion, and the mean estimated pressure gradient across the conduit was 19.6 ± 11.9 mm Hg at 5 years and appeared to reach a plateau thereafter. The pressure gradient across the conduit was 14.2 ± 8.0 mm Hg at 3 years (P = .0127) and 18.1 ± 7.5 mm Hg at 7 years (P = .0208).

Conclusions: Polytetrafluoroethylene conduits represent a valid option and reliable alternative to homograft and xenograft implantation for pulmonary reconstruction.