Options for Prosthetic Pulmonary Valve Replacement

Emani, Sitaram M.

doi:10.1053/j.pcsu.2012.01.015

Cited by 24 publications

(7 citation statements)

References 38 publications

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“…In this retrospective, observational, cohort study, the allocation of the 2 types of ePTFE conduit was decided only by the date of implantation except for the 4 months of transitional period, and the 2 groups were thought to be sufficiently comparable without any statistical corrections. Although the baseline characteristics of the patients in the 2 groups did not differ significantly, the proportion of patients who underwent the Ross operation was significantly greater in group N. Because the nonanatomic implantation of the conduit in RVOT reconstruction is known as an independent risk factor for conduit dysfunction, 16,17 this disproportion might work against group T. Except for this problem, all other data supported the statistical equivalency of the 2 groups; therefore, comparison between these 2 groups was thought to be appropriate.…”

Section: Discussionmentioning

confidence: 97%

Modification of expanded polytetrafluoroethylene valved conduit using the thin-type leaflets

Yamamoto

Yamagishi

Miyazaki

et al. 2018

The Journal of Thoracic and Cardiovascular Surgery

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Although the clinical outcomes did not differ within midterm observation, the thin-type expanded polytetrafluoroethylene leaflet was considered to be suitable for the small-sized conduits, but not for large-sized conduits, based on the comparison of the hemodynamic performance. Long-term follow-up is necessary to address the appropriate sheet type for middle-sized conduits and to estimate the durability of the thin-type leaflet.

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Section: Discussionmentioning

confidence: 97%

Modification of expanded polytetrafluoroethylene valved conduit using the thin-type leaflets

Yamamoto

Yamagishi

Miyazaki

et al. 2018

The Journal of Thoracic and Cardiovascular Surgery

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“…They are the valves of choice for children, adolescents, and adults. 20 All patients of PVR in our centre have bioprosthetic valves, porcine or pericardial valves. In our present study, matched cMRI data showed significant reduction in RV volumes but no changes in the RVEF.…”

Section: Discussionmentioning

confidence: 99%

“…They are the valves of choice for children, adolescents, and adults. 20 All patients of PVR in our centre have bioprosthetic valves, porcine or pericardial valves.…”

Section: Discussionmentioning

confidence: 99%

Porcine Versus Pericardial Pulmonary Valve Replacement in Adults With Prior Congenital Cardiac Surgery: Midterm Outcomes

Yuen

Lee

Bhatia

et al. 2019

World J Pediatr Congenit Heart Surg

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Background: Postcongenital heart surgery pulmonary regurgitation requires subsequent pulmonary valve replacement. We sought to compare the outcomes of pulmonary valve replacement after using bioprosthetic valves, porcine versus pericardial bioprosthesis. Method: Retrospective single-center study of consecutive pulmonary valve replacement in patients with pulmonary regurgitation following initial congenital cardiac surgery. From 2004 to 2016, 82 adult patients (53 males, 29 females) underwent pulmonary valve replacement at a mean age of 28.7 + 8 years (range 18-52 years) with a mean time to pulmonary valve replacement of 24 + 7 years (range 13-43 years). Porcine bioprosthetic valves (group 1, n ¼ 32) and pericardial valves (group 2, n ¼ 50) were used. Cardiac magnetic resonance imaging was performed (n ¼ 54) at a mean of 18 + 13 months before and 24 + 21 months after pulmonary valve replacement. Results: No significant difference was seen between the groups except that the mean follow-up was longer for group 1 (5.02 + 2.06 vs 4.08 + 3.21 years). In-hospital mortality was 1.1%. Follow-up completeness was 100% with no late death. Mean right ventricular end-systolic and end-diastolic volumes reduced significantly in both the groups (P < .001), whereas right ventricular ejection fraction remained unchanged (group 1, P ¼ .129; group 2, P ¼ .675). Only the left ventricular end-diastolic volume increased in both the groups, but the increase was significant for group 2 only (group 1, P ¼ .070; group 2, P ¼ .015), whereas the left ventricular end-systolic and ejection fraction remained unchanged in both the groups. There was no reoperation for pulmonary valve replacement. Freedom from intervention was 93.8% (group 1) and 100% (group 2) at eight years after pulmonary valve replacement (P ¼ .407). Conclusion: Midterm outcomes of pulmonary valve replacement in our adult cohort were satisfactory. Both types of bioprosthetic valves performed comparably for eight years and were a good option in adults.

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“…The homografts have been used in PVR and RVOT for several decades. Although they are capable of providing superior hemodynamic performance, free of anticoagulation and encouraging early-to mid-term outcomes, the discouraging long-term durability and limited availability constrained their clinical application (Emani, 2012). Bioprosthetic valves, which are usually constructed from the decellularized bovine or porcine pericardium, overcome the shortage of homograft.…”

Section: Introductionmentioning

confidence: 99%

In vitro Assessment of the Impacts of Leaflet Design on the Hemodynamic Characteristics of ePTFE Pulmonary Prosthetic Valves

Zhu

Wei

Yuan

et al. 2020

Front. Bioeng. Biotechnol.

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Prosthetic pulmonary valves are widely used in the management procedures of various congenital heart diseases, including the surgical pulmonary valve replacement (PVR) and right ventricular outflow tract reconstruction (RVOT). The discouraging long-term outcomes of standard prostheses, including homografts and bioprosthetic, constrained their indications. Recent developments in the expanded-polytetrafluoroethylene (ePTFE) pulmonary prosthetic valves provide promising alternatives. In this study, the hemodynamic characteristics of bileaflet and trileaflet ePTFE valve designs were experimentally evaluated. The in vitro tests were performed under the right ventricle (RV) flow conditions by using an in vitro RV circulatory system and particle image velocimetry (PIV). The leaflet kinetics, trans-valvular pressure gradients, effective orifice areas, regurgitant fractions, energy losses, velocity fields, and Reynolds shear stress (RSS) in both prostheses were evaluated. The opening of the bileaflet and trileaflet valve takes 0.060 and 0.088 s, respectively. The closing of the former takes 0.140 s, in contrast to 0.176 s of the latter. The trans-valvular pressure is 6.8 mmHg in the bileaflet valve vs. 7.9 mmHg in the trileaflet valve. The effective orifice area is 1.83 cm 2 in the bileaflet valve and 1.72 cm 2 in the trileaflet valve. The regurgitant fraction and energy loss of bileaflet are 7.13% and 82 mJ, which are 7.84% and 101.64 mJ in its bileaflet counterpart. The maximum RSS of 48.0 and 49.2 Pa occur at the systole peak in the bileaflet and trileaflet valve, respectively. A higher average RSS level is found in the bileaflet valve. The results from this preliminary study indicate that the current bileaflet prosthetic valve design is capable of providing a better overall hemodynamic performance than the trileaflet design.

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Options for Prosthetic Pulmonary Valve Replacement

Cited by 24 publications

References 38 publications

Modification of expanded polytetrafluoroethylene valved conduit using the thin-type leaflets

Modification of expanded polytetrafluoroethylene valved conduit using the thin-type leaflets

Porcine Versus Pericardial Pulmonary Valve Replacement in Adults With Prior Congenital Cardiac Surgery: Midterm Outcomes

In vitro Assessment of the Impacts of Leaflet Design on the Hemodynamic Characteristics of ePTFE Pulmonary Prosthetic Valves

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