Late results of right ventricular outflow tract reconstruction with a bicuspid expanded polytetrafluoroethylene valved conduit

Choi, Kyoo Wan; Sung, Si Chan; Kim, Hyungtae; Lee, Hyoung Doo; Kim, Geena; Ko, Hoon

doi:10.1111/jocs.13507

Cited by 11 publications

(6 citation statements)

References 15 publications

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“…In patients with a small pulmonary valve annulus, a TAP is still necessary for adequate RVOTO relief. Other techniques to preserve or replace pulmonary valve competence include pulmonary valvuloplasty with patching limited to the infundibulum 23, 24 , implantation of a monocusp valve 25, 26 , a valved RV-to-PA conduit 27, 28 , or a homograft valve 27 . A survival benefit of these valve-sparing or valve-replacing techniques has not yet been demonstrated 29– 32 .…”

Section: Surgical Approaches To Repairmentioning

confidence: 99%

Current outcomes and treatment of tetralogy of Fallot

et al. 2019

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Tetralogy of Fallot (ToF) is the most common type of cyanotic congenital heart disease. Since the first surgical repair in 1954, treatment has continuously improved. The treatment strategies currently used in the treatment of ToF result in excellent long-term survival (30 year survival ranges from 68.5% to 90.5%). However, residual problems such as right ventricular outflow tract obstruction, pulmonary regurgitation, and (ventricular) arrhythmia are common and often require re-interventions. Right ventricular dysfunction can be seen following longstanding pulmonary regurgitation and/or stenosis. Performing pulmonary valve replacement or relief of pulmonary stenosis before irreversible right ventricular dysfunction occurs is important, but determining the optimal timing of pulmonary valve replacement is challenging for several reasons. The biological mechanisms underlying dysfunction of the right ventricle as seen in longstanding pulmonary regurgitation are poorly understood. Different methods of assessing the right ventricle are used to predict impending dysfunction. The atrioventricular, ventriculo-arterial and interventricular interactions of the right ventricle play an important role in right ventricle performance, but are not fully elucidated. In this review we present a brief overview of the history of ToF, describe the treatment strategies currently used, and outline the long-term survival, residual lesions, and re-interventions following repair. We discuss important remaining challenges and present the current state of the art regarding these challenges.

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Section: Surgical Approaches To Repairmentioning

confidence: 99%

Current outcomes and treatment of tetralogy of Fallot

et al. 2019

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“…According to researchers from Korea, the conduit with the bicuspid ePTFE valve demonstrated good long-term durability, but along with a gradual increase of the pressure gradient. An increase in the pressure gradient was reported to be the main reason for the valve dysfunction, requiring reoperation [ 41 ].…”

Section: Historical Backgroundmentioning

confidence: 99%

Polymeric Heart Valves Will Displace Mechanical and Tissue Heart Valves: A New Era for the Medical Devices

Резвова

Klyshnikov

Грицкевич³

et al. 2023

IJMS

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The development of a novel artificial heart valve with outstanding durability and safety has remained a challenge since the first mechanical heart valve entered the market 65 years ago. Recent progress in high-molecular compounds opened new horizons in overcoming major drawbacks of mechanical and tissue heart valves (dysfunction and failure, tissue degradation, calcification, high immunogenic potential, and high risk of thrombosis), providing new insights into the development of an ideal artificial heart valve. Polymeric heart valves can best mimic the tissue-level mechanical behavior of the native valves. This review summarizes the evolution of polymeric heart valves and the state-of-the-art approaches to their development, fabrication, and manufacturing. The review discusses the biocompatibility and durability testing of previously investigated polymeric materials and presents the most recent developments, including the first human clinical trials of LifePolymer. New promising functional polymers, nanocomposite biomaterials, and valve designs are discussed in terms of their potential application in the development of an ideal polymeric heart valve. The superiority and inferiority of nanocomposite and hybrid materials to non-modified polymers are reported. The review proposes several concepts potentially suitable to address the above-mentioned challenges arising in the R&D of polymeric heart valves from the properties, structure, and surface of polymeric materials. Additive manufacturing, nanotechnology, anisotropy control, machine learning, and advanced modeling tools have given the green light to set new directions for polymeric heart valves.

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“…However, this artificial conduit was only used in a handful of heart centers outside of Japan ( 54 , 55 ). In the last decade, the application of 0.1 mm thick ePTFE for RVOT reconstruction has gradually increased in the form of bicuspid valves directly sutured into RVOT ( 56 , 57 ), or bicuspid/tricuspid valved conduits without bulging sinuses ( 32 , 58 ). Mercer et al reported a similar performance for bicuspid ePTFE valved conduits with homograft conduits in patients <2 years of age ( 59 ).…”

Section: Clinical Outcomes Of Available Conduitsmentioning

confidence: 99%

Conduits for Right Ventricular Outflow Tract Reconstruction in Infants and Young Children

et al. 2021

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Purpose of Review: Right ventricular outflow tract (RVOT) reconstruction remains a challenge due to the lack of an ideal conduit. Data and experience are accumulating with each passing day. Therefore, it is necessary to review this topic from time to time. This is a 2021 update review focused on the history, evolution, and current situation of small-sized conduits (≤ 16 mm) for RVOT reconstruction in infants and young children.Recent Findings: Currently, the available small-sized (≤16 mm) conduits can meet most clinical needs. Homograft is still a reliable choice for infants and young children validated by a half-century clinical experience. As an alternative material, bovine jugular vein conduit (BJVC) has at least comparable durability with that of homograft. The performance of expanded polytetrafluoroethylene (ePTFE) is amazing in RVOT position according to limited published data. The past century has witnessed much progress in the materials for RVOT reconstruction. However, lack of growth potential is the dilemma for small-sized conduits. Tissue-engineering based on cell-free scaffolds is the most promising technology to obtain the ideal conduit.Summary: No conduit has proved to have lifelong durability in RVOT position. We are far from the ideal, but we are not in a state of emergency. In-depth clinical research as well as innovation in material science are needed to help improve the durability of the conduits used in infants and young children.

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Late results of right ventricular outflow tract reconstruction with a bicuspid expanded polytetrafluoroethylene valved conduit

Abstract: ePTFE bicuspid valved conduit has good late function in terms of valve regurgitation, but the pressure gradient across the conduit increases with time, which is the main cause of conduit failure and explantation.

Cited by 11 publications

References 15 publications

Current outcomes and treatment of tetralogy of Fallot

Current outcomes and treatment of tetralogy of Fallot

Polymeric Heart Valves Will Displace Mechanical and Tissue Heart Valves: A New Era for the Medical Devices

Conduits for Right Ventricular Outflow Tract Reconstruction in Infants and Young Children

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