Bicuspid pulmonary valve implantation using polytetrafluoroethylene membrane: early results and assessment of the valve function by magnetic resonance imaging

Lee, Cheul; Lee, Chang Ha; Kwak, Jae Gun; Song, June O.; Shim, Woo Sup; Choi, Eun Young; Lee, Sangyun; Kim, Yang Min

doi:10.1093/ejcts/ezs381

Cited by 20 publications

(18 citation statements)

References 20 publications

(36 reference statements)

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“…Recently, we reported early results of this technique in 56 patients with various congenital heart diseases. 41 In our experience, this valve demonstrated excellent performance for the short term -median follow-up duration of 15 months -as assessed by echocardiography and magnetic resonance imaging (Fig 3). Analysis of the pre-operative and post-operative magnetic resonance imaging data in patients with pulmonary regurgitation showed significant reduction in right ventricular volumes and improvement in biventricular function (Table 1).…”

Section: Options For Surgical Pulmonary Valve Replacementmentioning

confidence: 73%

Surgical pulmonary valve insertion

Lee

Kwak

2013

Cardiol Young

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Pulmonary valve replacement is being performed with increasing frequency in patients with various congenital heart diseases. Chronic pulmonary regurgitation after repair of tetralogy of Fallot is a typical situation that requires pulmonary valve replacement. Chronic pulmonary regurgitation after repair of tetralogy of Fallot can lead to right ventricular dilatation, biventricular dysfunction, heart failure symptoms, arrhythmias, and sudden death. Although pulmonary valve replacement can lead to improvement in functional class and a substantial decrease or normalisation of right ventricular volumes, the optimal timing of pulmonary valve replacement in patients with chronic pulmonary regurgitation is still unknown. There are several options for surgical pulmonary valve replacement. However, no ideal pulmonary valve substitute exists currently and most of the surgically implanted pulmonary valves will eventually require re-replacement. This article will review options and timing of surgical pulmonary valve insertion in patients with chronic pulmonary regurgitation after repair of tetralogy of Fallot.

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Section: Options For Surgical Pulmonary Valve Replacementmentioning

confidence: 73%

Surgical pulmonary valve insertion

Lee

Kwak

2013

Cardiol Young

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“…Some proponents of a valve in the right ventricular outflow tract have had noted that the monocusp valve has not been particularly effective and started using a bicuspid valve that can be constructed of Gore‐tex or polytetrafluoroethylene membrane. Descriptive studies have demonstrated data that may indicate that such valves may outperform monocusp valves . However, no direct comparison of the two has been performed.…”

Section: Discussionmentioning

confidence: 99%

“…Descriptive studies have demonstrated data that may indicate that such valves may outperform monocusp valves. 16,17 However, no direct comparison of the two has been performed. Also, development of fibrosis of the constructed valve is thought to contribute to loss of valve function.…”

Section: Preoperativementioning

confidence: 99%

Monocusp valve placement in children with tetralogy of Fallot undergoing repair with transannular patch: A functioning pulmonary valve does not improve immediate postsurgical outcomes

Singh

Loomba

Gudausky

et al. 2018

Congenital Heart Disease

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Introduction In patients with tetralogy of Fallot (TOF), use of transannular patch (TAP) may be required in order to relieve significant right ventricular outflow tract obstruction, subsequently resulting in pulmonary insufficiency (PI). The monocusp valve has been used to temporarily reduce insufficiency in hopes to improve short and midterm outcomes. The purpose of this study was to assess for potential benefits of the monocusp valve in this subset of patients. Design Between 2005 and 2016, 119 patients with TOF with pulmonary stenosis who underwent repair with TAP were analyzed, 43 (36.1%) had a monocusp valve placed. Immediate outcomes were assessed by postoperative echocardiograms, ICU data including time to extubation, chest tube duration, reintervention, length of stay, and mortality. Results Median age of repair was similar for monocusp group at 143.5 days and nonmonocusp at 137.0 days (P = .93). Peak preoperative right ventricular outflow tract obstruction was higher in the monocusp group (80 mm Hg vs. 70 mm Hg, P ≤ .01). Patients who had monocusp placed had longer bypass time. There was less PI for monocusp group immediately after repair and at discharge (P ≤ .01). There was no difference in days of intubation, chest tube duration, length of hospitalization, reintervention rates, or mortality. Conclusion Decreasing the degree of PI with a monocusp valve in patients undergoing repair for TOF repair with TAP does not improve clinical outcomes in the immediate postoperative period.

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“…This extremely low porosity (distance of fiber nodes <1 um) of UEPTFE makes cellular or fibrinous adherence more difficult and is theoretically resistant to pannus formation or calcification. The monocusp valve [21], bicuspid valve [22], and trileaflet valve [23] made of UEPTFE have successfully been implanted in men with CHD for pulmonary reconstruction, and have demonstrated satisfactory clinical effects. Ando et al [23] reported their ten-year experience with handmade trileaflet UEPTFE valved conduit used for pulmonary reconstruction in 139 patients with no postoperative anticoagulation.…”

Section: Discussionmentioning

confidence: 99%

Transcatheter Pulmonary Valve Replacement by Hybrid Approach Using a Novel Polymeric Prosthetic Heart Valve: Proof of Concept in Sheep

Zhang

Chen

et al. 2014

PLoS ONE

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BackgroundSince 2000, transcatheter pulmonary valve replacement has steadily advanced. However, the available prosthetic valves are restricted to bioprosthesis which have defects like poor durability. Polymeric heart valve is thought as a promising alternative to bioprosthesis. In this study, we introduced a novel polymeric transcatheter pulmonary valve and evaluated its feasibility and safety in sheep by a hybrid approach.MethodsWe designed a novel polymeric trileaflet transcatheter pulmonary valve with a balloon-expandable stent, and the valve leaflets were made of 0.1-mm expanded polytetrafluoroethylene (ePTFE) coated with phosphorylcholine. We chose glutaraldehyde-treated bovine pericardium valves as control. Pulmonary valve stents were implanted in situ by a hybrid transapical approach in 10 healthy sheep (8 for polymeric valve and 2 for bovine pericardium valve), weighing an average of 22.5±2.0 kg. Angiography and cardiac catheter examination were performed after implantation to assess immediate valvular functionality. After 4-week follow-up, angiography, echocardiography, computed tomography, and cardiac catheter examination were used to assess early valvular function. One randomly selected sheep with polymeric valve was euthanized and the explanted valved stent was analyzed macroscopically and microscopically.FindingsImplantation was successful in 9 sheep. Angiography at implantation showed all 9 prosthetic valves demonstrated orthotopic position and normal functionality. All 9 sheep survived at 4-week follow-up. Four-week follow-up revealed no evidence of valve stent dislocation or deformation and normal valvular and cardiac functionality. The cardiac catheter examination showed the peak-peak transvalvular pressure gradient of the polymeric valves was 11.9±5.0 mmHg, while that of two bovine pericardium valves were 11 and 17 mmHg. Gross morphology demonstrated good opening and closure characteristics. No thrombus or calcification was seen macroscopically.ConclusionsThis design of the novel ePTFE transcatheter pulmonary valve is safe and effective to deploy in sheep by hybrid approach, and the early valvular functionality is good.

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Bicuspid pulmonary valve implantation using polytetrafluoroethylene membrane: early results and assessment of the valve function by magnetic resonance imaging

Abstract: Early results of bicuspid PV implantation using PTFE membrane were satisfactory. PTFE bicuspid PV demonstrated excellent performance for the short term as evidenced by echocardiography and MRI. Long-term follow-up is mandatory to determine the durability of this valve.

Cited by 20 publications

References 20 publications

Surgical pulmonary valve insertion

Surgical pulmonary valve insertion

Monocusp valve placement in children with tetralogy of Fallot undergoing repair with transannular patch: A functioning pulmonary valve does not improve immediate postsurgical outcomes

Transcatheter Pulmonary Valve Replacement by Hybrid Approach Using a Novel Polymeric Prosthetic Heart Valve: Proof of Concept in Sheep

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