PTFE monocusp valve reconstruction of the right ventricular outflow tract.
BACKGROUND
Transannular patching of right ventricular outflow tract obstructive (RVOTO) defects results in pulmonary insufficiency (PI). Biologic monocusp valves (MO) can prevent acute PI but are prone to early degeneration and progressive regurgitation. Polytetrafluoroethylene (PTFE, 0.1 mm) MO leaflets demonstrated favorable characteristics in animal studies, and the technique was applied to a variety of RVOTO anomalies.


METHODS
From June 1990 through June 1999, 158 patients underwent either PTFE MO RVOT reconstruction (n = 115 patients; 120 implants) or nonvalved transannular repair (TA) repairs (n = 43 patients; 5 subsequent MO implants) at our institution. Standard MO construction techniques and TA repairs were utilized. Intraoperative, postoperative, and echocardiographic data with a mean interval of 2.6 years (range 6 months to 8 years) were used in retrospective fashion to compare clinical outcomes. In addition, PTFE monocusp valves beyond 6 months postimplant underwent echocardiographic analysis of MO function and durability.


RESULTS
There were 4 early (MO-3, TA-1) and no late deaths. Overall, perioperative complications were not significantly different between MO and TA groups, nor were total hospitalization days (9.1 versus 10.7, p = 0.24). However, a significant difference in intensive care unit (ICU) utilization (3.6 versus 5.8 days, p = 0.03) favored MO patients. Patients with tetralogy of Fallot (TOF) and ventricular septal defect/pulmonary atresia (VSD/PA) undergoing the MO implant demonstrated a trend toward improved survival (p = 0.08) when compared to TA repairs. Intraoperative PI was graded mild in the MO group and moderate-severe in the TA group (p = 0.003). Progressive MO regurgitation occurred (mild-moderate) but remained significantly less than the transannular patch repairs (p < 0.05).


CONCLUSIONS
Utilization of a PTFE MO valve prevents short-term and significantly reduces midterm PI. It is inexpensive, easy to construct, and demonstrates no evidence of stenosis, calcification, or embolization. Despite longer cardiopulmonary bypass and ischemic times, it reduces ICU stay and, in both TOF and VSD/PA patients, decreases operative morbidity and mortality.
Turrentine
Mark W
MW
Department of Surgery, Indiana University School of Medicine, Indianapolis,. mturren@iupui.edu
McCarthy
Ryan P
RP
Vijay
Palaniswamy
P
McConnell
Kevin W
KW
Brown
John W
JW
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D006345:Heart Septal Defects, Ventricular / Q000601:surgery; D006350:Heart Valve Prosthesis; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011138:Polytetrafluoroethylene / Q000627:therapeutic use; D018633:Pulmonary Atresia / Q000601:surgery; D013771:Tetralogy of Fallot / Q000601:surgery; D014694:Ventricular Outflow Obstruction / Q000601:surgery*
D011138:Polytetrafluoroethylene