Right ventricular outflow tract strategies for repair of tetralogy of Fallot: effect of monocusp valve reconstruction

Sasson, Lior; Houri, Sion; Sternfeld, Alona Raucher; Cohen, I.; Lenczner, Orit; Bove, Edward L.; Kapusta, Livia; Tamir, A.

doi:10.1093/ejcts/ezs479

Cited by 57 publications

(69 citation statements)

References 22 publications

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“…Several materials have been tested clinically for reconstructing the RVOT, [22][23][24][25][26][27][28][29] but their common limitation is the lack of a growth potential that leads to reoperations, with their attendant risk of increased morbidity and mortality.…”

Section: Discussionmentioning

confidence: 99%

Polymer-Based Reconstruction of the Inferior Vena Cava in Rat: Stem Cells or RGD Peptide?

Pontailler

Illangakoon

Williams

et al. 2015

Tissue Engineering Part A

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As part of a program targeted at developing a resorbable valved tube for replacement of the right ventricular outflow tract, we compared three biopolymers (polyurethane [PU], polyhydroxyalkanoate (the poly(3-hydroxybutyrate-co-3-hydroxyvalerate-co-4-hydroxyvalerate) [PHBVV]), and polydioxanone [PDO]) and two biofunctionalization techniques (using adipose-derived stem cells [ADSCs] or the arginine-glycine-aspartate [RGD] peptide) in a rat model of partial inferior vena cava (IVC) replacement. Fifty-three Wistar rats first underwent partial replacement of the IVC with an acellular electrospun PDO, PU, or PHBVV patch, and 31 nude rats subsequently underwent the same procedure using a PDO patch biofunctionalized either by ADSC or RGD. Results were assessed both in vitro (proliferation and survival of ADSC seeded onto the different materials) and in vivo by magnetic resonance imaging ( MRI), histology, immunohistochemistry [against markers of vascular cells (von Willebrand factor [vWF], smooth muscle actin [SMA]), and macrophages ([ED1 and ED2] immunostaining)], and enzyme-linked immunosorbent assay (ELISA; for the expression of various cytokines and inducible NO synthase). PDO showed the best in vitro properties. Six weeks after implantation, MRI did not detect significant luminal changes in any group. All biopolymers were evenly lined by vWF-positive cells, but only PDO and PHBVV showed a continuous layer of SMA-positive cells at 3 months. PU patches resulted in a marked granulomatous inflammatory reaction. The ADSC and RGD biofunctionalization yielded similar outcomes. These data confirm the good biocompatibility of PDO and support the concept that appropriately peptide-functionalized polymers may be successfully substituted for cell-loaded materials.

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Section: Discussionmentioning

confidence: 99%

Polymer-Based Reconstruction of the Inferior Vena Cava in Rat: Stem Cells or RGD Peptide?

Pontailler

Illangakoon

Williams

et al. 2015

Tissue Engineering Part A

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“…They had a total of 163 patients with the diagnosis of TOF with pulmonary stenosis, divided into three cohorts: pulmonary valve sparing procedure, TAP without monocusp, and TAP with monocusp. Their study noted decreased duration of mechanical ventilation, intensive care unit stay, and chest tube duration . Although Sasson and colleagues noted improved postoperative outcomes, it is important to note they had a significantly older mean age at time of repair in all their cohorts (27 months in the nonmonocusp and 20.5 months in the monocusp group) compared to our population (4.8 months in the nonmonocusp and 4.6 months in the monocusp group).…”

Section: Discussionmentioning

confidence: 50%

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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“…The monocusp may be constructed with various materials such as autogenous or bovine pericardium, polytetrafluoroethylene (PTFE) membrane, and extracellular matrix. [12,13] In standard practice, the monocusp is prepared by cutting it as a semicircle to fit the length of the RVOT incision from the apex to the pulmonary annulus and the width of the diameter of the pulmonary annulus. The monocusp is attached by leaving 1 mm excess on both sides and suturing it to the pulmonary valve commissures and the apex of the RVOT incision at three different points.…”

Section: Discussionmentioning

confidence: 99%

“…The suture used to close the transannular incision is continued on both ends and stitched to the ventriculotomy. [12,13] Likewise, we applied monocusp with autogenous pericardium with the standard technique in all of our patients. While the literature describes various new techniques on pulmonary valve reconstruction, the superiority of these techniques to the standard monocusp application in terms of durability and degeneration is under debate.…”

Section: Discussionmentioning

confidence: 99%

The impact of pulmonary valve-sparing techniques on postoperative early and midterm results in tetralogy of Fallot repair

Aydın

Suzan

Temur

et al. 2018

Turk Gogus Kalp Dama

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ÖZAmaç: Bu çalışmada pulmoner kapağı korunarak ameliyat edilen hastalar, transanüler yama tekniği uygulanan hastalarla erken ve orta dönem sonuçları açısından incelendi.Ça lış m apla nı:Fallot tetralojisi tanısı ile Kasım 2010 -Eylül 2015 tarihleri arasında aynı cerrah tarafından tam düzeltme uygulanan toplam 64 hasta bu çalışmaya dahil edildi. Hastaların ortalama yaşı 20.0±14.2 ay (5.5-96 ay) idi. Kırk hasta (%62.5) erkek idi. Otuz iki hasta (%50) bir yaşın altındaydı. Otuz beş hastaya transanüler yama tekniği ile (Grup 1), 29 hastaya pulmoner kapak koruma tekniği ile (Grup 2) cerrahi uygulandı. Grup 1'deki hastaların 15'ine otojen perikard ile pulmoner monokusp oluşturuldu. Grup 2'deki hastaların dokuzuna transatriyal, sekizine transatriyal-transpulmoner, sekizine infundibüler yama, dördüne kombine infundibüler ve pulmoner yama ile tam düzeltme uygulandı.Bul gu lar: Grup 2'de erken mortalite görülmedi. Grup 1'de beş hasta (%14.2) erken dönemde kaybedildi (p= 0.058). Bu hastaların ikisine monokusp replasmanı (%13.3) uygulanmıştı (p=1). Mortalite nedenleri ani kardiyak arrest (n=2), multiorgan yetmezliği (n=1), düşük kardiyak debi (n=1), nörolojik komplikasyon (n=1) idi. Grup 1'de beş hasta ekstrakorporeal membran oksijenasyon (ECMO) desteğine alındı. Üç hasta ECMO'dan ayrıldı. ECMO'dan ayrılan iki hasta sorunsuz taburcu edildi. Total ameliyat sonrası morbidite oranı Grup 1'de anlamlı olarak yüksekti (%51.4'e karşın %6.8) (p= 0.0001). Grup 1'de pulmoner monokusp uygulanan hastalarda morbidite oranı aynı gruptaki diğer hastalara göre anlamlı olarak düşüktü (p= 0.0176). Hastalardan 49'u (%83), median 6.5 ay (1-24 ay) takip edildi. Grup 1'de monokusp uygulanmayan tüm hastalarda serbest pulmoner kapak yetmezliği saptanırken, grup 2'deki hastalarda pulmoner kapak yetmezliği yoktu veya hafif derecede idi. Grup 1 içerisindeki monokusp uygulanan hastaların 12'si (%80) takip edildi. Bu hastaların sadece ikisinde serbest pulmoner kapak yetmezliği (%16.6) tespit edildi. Geri kalanlarda hafif (n= 6) veya hafif-orta pulmoner kapak yetmezliği (n= 4) vardı.So nuç:Fallot tetralojisi tamiri sırasında, pulmoner kapağı korunan hastalarda mortalite ve morbidite daha düşüktür. Transanüler yama gereken hastalarda monokusp pulmoner kapak uygulaması sonuçları iyileştirebilir. Tamir sırasında kompetan bir pulmoner kapak elde etmek için çaba gösterilmesi önerilebilir.Anah tarsöz cük ler: Monokusp; pulmoner kapak koruma; Fallot tetralojisi; transanüler yama. ABSTRACTBackground: In this study, we analyzed the impact of pulmonary valve-sparing techniques on early and midterm postoperative results of tetralogy of Fallot repair. Methods:A total of 64 patients diagnosed with tetralogy of Fallot, who underwent total correction operation by the same surgeon between November 2010 and September 2015 were included in this retrospective study. Mean age of the patients was 20.0±14.2 months (5.5-96 months). Forty patients (62.5%) were male. Thirty two of the patients (50%) were under one year of age. Pulmonary valve-sparing techniques were performed in...

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Right ventricular outflow tract strategies for repair of tetralogy of Fallot: effect of monocusp valve reconstruction

Abstract: The use of a PTFE membrane monocusp valve and a valve-sparing strategy prevents immediate PI and improves short-term clinical outcomes. PTFE membrane monocusp appears advantageous in preventing severe intermediate-term PI and facilitates the preservation of RV function.

Cited by 57 publications

References 22 publications

Polymer-Based Reconstruction of the Inferior Vena Cava in Rat: Stem Cells or RGD Peptide?

Polymer-Based Reconstruction of the Inferior Vena Cava in Rat: Stem Cells or RGD Peptide?

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

The impact of pulmonary valve-sparing techniques on postoperative early and midterm results in tetralogy of Fallot repair

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