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  • Title: Modification of expanded polytetrafluoroethylene valved conduit using the thin-type leaflets.
    Author: Yamamoto Y, Yamagishi M, Miyazaki T, Asada S, Maeda Y, Yaku H, Kado H.
    Journal: J Thorac Cardiovasc Surg; 2018 Oct; 156(4):1629-1636.e3. PubMed ID: 29807772.
    Abstract:
    OBJECTIVES: The expanded polytetrafluoroethylene conduit with fan-shaped leaflets and bulging sinuses for right ventricular outflow tract reconstruction was modified with a newly developed thin-type expanded polytetrafluoroethylene leaflet. The purpose of this study was to evaluate the clinical outcomes and hemodynamic performance of the modified conduit. METHODS: From January 2010 to December 2013, 149 patients underwent definitive right ventricular outflow tract reconstruction using the expanded polytetrafluoroethylene conduit; the 55 patients receiving a conventional conduit (group N) were compared with the 94 patients receiving a modified conduit (group T). RESULTS: There were no conduit-related deaths, operative deaths, or reimplantations for conduit failure. The overall survival and freedom from reintervention for conduit-related reasons at 3 years were 98.2% versus 95.6% (P = .438) and 94.7% versus 97.9% (P = .954) for groups N and T, respectively. The mean peak pressure gradients were 22.6 ± 15.6 mm Hg versus 18.2 ± 11.5 mm Hg (P = .161), and in the subanalysis within small-sized conduits, they were 30.2 ± 16.5 mm Hg versus 20.4 ± 10.7 mm Hg (P = .034). Regarding conduit insufficiency, the modified conduit showed a significantly worse grade of insufficiency (P = .014) only in the subanalysis within large-sized conduits. CONCLUSIONS: 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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