title: Smaller-Sized Expanded Polytetrafluoroethylene Conduits With a Fan-Shaped Valve and Bulging Sinuses for Right Ventricular Outflow Tract Reconstruction.
abstract: BACKGROUND
  One of the critical factors limiting conduit longevity in right ventricular outflow tract (RVOT) reconstruction with homografts and xenografts is the small size of the conduit. The aim of our study was to assess the outcome of using smaller-sized expanded polytetrafluoroethylene (ePTFE) conduits with a fan-shaped valve and bulging sinuses for RVOT reconstruction.
  
  
  METHODS
  This retrospective review examined 303 patients who underwent RVOT reconstruction with ePTFE conduits at 63 Japanese hospitals between 2003 and 2014. Inclusion criteria were a conduit size less than or equal to 16 mm and the use of operative treatment as the primary correction for underlying heart disease. Patients undergoing palliative procedures were excluded.
  
  
  RESULTS
  Median follow-up was 1.7 years. Freedom from conduit replacement and freedom from conduit reintervention were 90.1% ± 4.8% and 77.2% ± 5.6%, respectively. The most common indication for conduit reintervention was pulmonary artery (PA) bifurcation stenosis (82%). Modeling z-scores as a dichotomous variable revealed that freedom from conduit reintervention for PA bifurcation stenosis was significantly decreased for conduits with a z-score greater than or equal to 1.4 compared with z-scores less than 1.4 (p = 0.036). There were 30 patients (9.9%) who experienced at least moderate conduit stenosis and 21 patients (6.9%) with at least moderate conduit insufficiency. Univariate Cox regression analysis showed that conduit size was a significant factor for conduit stenosis (p = 0.006).
  
  
  CONCLUSIONS
  Excellent midterm outcomes were achieved with ePTFE valved conduits, even when using smaller sizes. Conduit z-scores around 1.4 were optimal for RVOT reconstruction in younger patients.
authors.affiliation: Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors.forename: Eijiro
authors.initials: E
authors.lastname: Yamashita
authors.affiliation: Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan. Electronic address: myama@koto.kpu-m.ac.jp.
authors.forename: Masaaki
authors.initials: M
authors.lastname: Yamagishi
authors.affiliation: Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors.forename: Takako
authors.initials: T
authors.lastname: Miyazaki
authors.affiliation: Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Maeda
authors.affiliation: Department of Pediatric Cardiovascular Surgery, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Yamamoto
authors.affiliation: Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors.forename: Nobuyasu
authors.initials: N
authors.lastname: Kato
authors.affiliation: Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Asada
authors.affiliation: Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors.forename: Hisayuki
authors.initials: H
authors.lastname: Hongu
authors.affiliation: Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Yaku
mesh_terms: D000293:Adolescent; D000367:Age Factors; D006348:Cardiac Surgical Procedures / Q000379:methods; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D006350:Heart Valve Prosthesis; D006352:Heart Ventricles / Q000002:abnormalities / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011138:Polytetrafluoroethylene; D019651:Plastic Surgery Procedures / Q000379:methods* / Q000401:mortality; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D011138:Polytetrafluoroethylene