Right ventricular outflow tract reconstruction using a polytetrafluoroethylene conduit in Ross patients†

Sharifulin, Ravil; Bogachev-Prokophiev, Alexander; Демин, И. И.; Железнев, С. И.; Pivkin, Alexey; Afanasyev, Alexander; Karaskov, Alexander

doi:10.1093/ejcts/ezy128

Cited by 14 publications

(9 citation statements)

References 29 publications

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“…The clinical results from Japan were excellent. 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 ).…”

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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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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“…PTFE valved conduits show excellent hemodynamic performance in preclinical in vitro and in vivo experiments ( 95 – 97 ). The results of mid-term clinical trials showed less need for further intervention and severe valvular dysfunction ( 98 , 99 ), especially in valvular regurgitation ( 100 ). And the failure incidence of this conduit is lower than that of autologous pericardial valved conduit operation ( 101 ).…”

Section: Xenograft Valved Conduits and Other Possible Alternativesmentioning

confidence: 99%

Application of Homograft Valved Conduit in Cardiac Surgery

Huyan

Chang

Song

2021

Front. Cardiovasc. Med.

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Valved conduits often correct the blood flow of congenital heart disease by connecting the right ventricle to the pulmonary artery (RV-PA). The homograft valved conduit was invented in the 1960s, but its wide application is limited due to the lack of effective sterilization and preservation methods. Modern cryopreservation prolongs the preservation time of homograft valved conduit, which makes it become the most important treatment at present, and is widely used in Ross and other operations. However, homograft valved conduit has limited biocompatibility and durability and lacks any additional growth capacity. Therefore, decellularized valved conduit has been proposed as an effective improved method, which can reduce immune response and calcification, and has potential growth ability. In addition, as a possible substitute, commercial xenograft valved conduit has certain advantages in clinical application, and tissue engineering artificial valved conduit needs to be further studied.

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“…Surgery for congenital heart disease often requires implantation of conduits for repair, conduits which do not have growth potential and will require multiple repeat interventions or operations [1][2][3][4]. There is an ongoing search for bioactive conduits that grow with a patient, potentially eliminating the need for repeated surgical procedures to replace faulty valves and outgrown conduits [5][6][7][8][9][10][11][12][13][14][15]. We have developed a unique cardiovascular conduit with an anisotropic capacity for stretching, by manipulating an expanded polytetrafluoroethylene (ePTFE) polymer sheet with directionally dependent expansion properties.…”

Section: Introductionmentioning

confidence: 99%

Feasibility Study of Catheter-Based Interventions for Anisotropic Expanded Polytetrafluoroethylene Cardiovascular Conduits in a Growing Lamb Model

Azakie

Carney

Lahti

et al. 2020

Journal of Investigative Surgery

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Background: Cardiovascular repair in children often requires implant of conduits which do not have growth potential and will require reoperation. In the current study we sought to determine the feasibility of catheter-based interventions of anisotropic conduits inserted as interposition grafts in the main pulmonary artery (MPA) of growing lambs. Methods: Lambs underwent interpositional implant of either an anisotropic expanded polytetrafluoroethylene (ePTFE) (Test) conduit or conventional PTFE (Control) conduit. In the postoperative period, lambs were anesthetized and underwent catheter-based interventions consisting of hemodynamic and angiographic data collection, balloon dilation and/or stenting of the conduit at 3, 6 or 9 month postoperative time point. Results: At 3 months, control lambs showed significant increases in right ventricular pressures and trans-conduit gradients in comparison to test lambs. Test conduit diameters were significantly larger compared to controls due to spontaneous radial expansion of the anisotropic conduit. Balloon dilation of test conduits at 3 and 6 months showed a reduction in RV pressure and statistically significant improvement in the RV outflow tract gradient as well as significant increase in graft diameter, compared to both control and pre-dilation conditions. Furthermore, the test conduit diameter increased significantly compared to the pre-balloon and control conditions at each time point. Necropsy of test conduits showed no evidence of tears, perforations, or clot and smooth interiors with well-healed anastomoses. Conclusions: Anisotropic conduits implanted as interposition grafts in the MPA show spontaneous expansion, and can safely and effectively undergo catheter-based interventions, with significant increases in graft diameter occurring after balloon dilation.

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Right ventricular outflow tract reconstruction using a polytetrafluoroethylene conduit in Ross patients†

Abstract: The PTFE conduit demonstrates acceptable haemodynamic results at the mid-term follow-up and could be considered as an alternative substitute for RVOT reconstruction during the Ross procedure.

Cited by 14 publications

References 29 publications

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

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

Application of Homograft Valved Conduit in Cardiac Surgery

Feasibility Study of Catheter-Based Interventions for Anisotropic Expanded Polytetrafluoroethylene Cardiovascular Conduits in a Growing Lamb Model

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