Long-term Outcomes of Polytetrafluoroethylene Bicuspid Pulmonary Valve Replacement.

BACKGROUND: In 2016 we reported promising midterm outcomes of bicuspid pulmonary valve replacement using 0.1-mm polytetrafluoroethylene (PTFE) membrane. This follow-up study analyzes long-term outcomes and risk factors for reintervention and structural valve deterioration (SVD). METHODS: We performed a retrospective review of the original 119 patients who underwent PTFE bicuspid pulmonary valve replacement. Median patient age was 16.9 years (range, 0.4-57.1). Reintervention was defined as any surgical or percutaneous catheter procedure on the PTFE valve. SVD was defined as development of a peak pressure gradient ≥ 50 mm Hg or at least a moderate amount of pulmonary regurgitation on follow-up echocardiography. RESULTS: The median follow-up duration was 9.5 years. The survival rate was 96.5% at 5 and 10 years, with 2 early and 2 late mortalities. Freedom from reintervention was 90.0% at 5 years and 63.3% at 10 years. Freedom from SVD was 92.8% at 5 years and 51.1% at 10 years, with regurgitation the predominant mode (64.6%). Freedom from both reintervention and SVD at 5 and 10 years were 89.1% and 49.5%, respectively. Multivariable analysis identified smaller valve diameter (hazard ratio, 0.82; P < .001) and more than trivial pulmonary regurgitation at discharge (hazard ratio, 5.81; P < .001) as risk factors for reintervention or SVD. CONCLUSIONS: Long-term results of the PTFE bicuspid pulmonary valve replacement were acceptable. However, improvements may be needed to reduce technical error and improve durability. Smaller valve diameter and more than trivial pulmonary regurgitation at discharge were risk factors for reintervention or SVD, warranting careful follow-up for timely reintervention.

Midterm follow-up of the status of Gore-Tex graft after extracardiac conduit Fontan procedure.

OBJECTIVE: Extracardiac conduit Fontan procedure has some theoretical advantages over other types of Fontan procedures, such as optimized flow dynamics, a lower frequency of arrhythmias, and technical ease of procedure. However, lack of growth potential and thrombogenicity of the artificial conduit is the main concern and can possibly lead to reoperation for the conduit stenosis. In this study, we investigated the change and the status of the Gore-Tex graft used in extracardiac conduit Fontan procedure. METHODS: Between 1996 and 2005, 154 patients underwent extracardiac conduit Fontan procedure using Gore-Tex graft. Among these, 46 patients underwent cardiac catheterization during follow-up period. We measured the internal diameter of the conduit and inferior vena cava angiographically. RESULTS: Mean follow-up duration was 36.1+/-19.7 months. The conduit diameter used was 16 mm in 10 patients, 18 mm in 16, 20 mm in 14, 22 mm in 4, and 24 mm in 2 patients. The mean conduit-to-inferior vena cava cross-sectional area ratio was 1.25+/-0.33. According to the conduit size used, this ratio was 1.03+/-0.17 for 16 mm conduits, 1.33+/-0.37 for 18 mm, 1.33+/-0.36 for 20 mm, 1.28+/-0.26 for 22 mm, and 1.05+/-0.06 for 24 mm conduits (p<0.05, 16 mm vs 18 mm and 20 mm). The mean percent decrease of the conduit cross-sectional area was 14.3+/-8.5%, and this did not differ significantly according to the conduit size (p=0.82). Follow-up duration and the percent decrease of the conduit cross-sectional area did not show significant correlation (r=0.22, p=0.14). There was no reoperation due to conduit stenosis. CONCLUSIONS: During midterm follow-up of about 3 years, the conduit cross-sectional area decreased by 14%, and this did not differ according to the conduit size used. The extent of decrease of the conduit cross-sectional area remained stable irrespective of the follow-up duration. Sixteen millimeters conduit showed no evidence of clinically significant stenosis, but careful follow-up is warranted because of the possible conduit stenosis relative to the patients' somatic growth.

Polytetrafluoroethylene Bicuspid Pulmonary Valve Replacement: A 5-Year Experience in 119 Patients With Congenital Heart Disease.

BACKGROUND: Durability of bioprosthetic valves in the pulmonary position is suboptimal. The objective of this study was to evaluate midterm outcomes of hand-sewn polytetrafluoroethylene (PTFE) bicuspid pulmonary valve replacement. METHODS: A retrospective review of 119 patients who underwent bicuspid pulmonary valve replacement using 0.1-mm PTFE membrane between June 2009 and May 2014 was performed. Reintervention was defined as any surgical or percutaneous catheter procedure on the PTFE pulmonary valve. Structural valve deterioration (SVD) was defined as development of a peak pressure gradient equal to or greater than 50 mm Hg or at least a moderate amount of pulmonary regurgitation on follow-up echocardiography. RESULTS: The median age at pulmonary valve replacement was 16.9 years (range 5 months to 57.1 years). Fundamental diagnoses were tetralogy of Fallot (n = 71), pulmonary atresia with ventricular septal defect (n = 21), double-outlet right ventricle (n = 13), and others (n = 14). The median valve size was 26 mm (range 12 to 30 mm). Two hospital deaths (1.7%) occurred, from ventricular dysfunction and infective endocarditis. At discharge, no patient showed significant pulmonary regurgitation or stenosis. Follow-up completeness was 94.0%, and the median duration of follow-up was 2.6 years (range 0.1 to 5.2 years). One late death occurred, the result of infective endocarditis involving the PTFE pulmonary valve. Actuarial survival was 97.1% ± 1.6% at 5 years. One patient underwent excision of the PTFE pulmonary valve because of infective endocarditis. Freedom from pulmonary valve reoperation was 99.1% ± 0.9% at 5 years. Ten patients developed SVD during follow-up, and 6 of them underwent an interventional catheter procedure. Freedom from pulmonary valve reintervention and SVD at 5 years was 90.7% ± 3.4% and 86.5% ± 4.0%, respectively. CONCLUSIONS: Midterm outcomes of hand-sewn PTFE bicuspid pulmonary valve replacement were acceptable. Long-term follow-up of this cohort is mandatory to determine the durability of this valve.

Bicuspid pulmonary valve implantation using polytetrafluoroethylene membrane: early results and assessment of the valve function by magnetic resonance imaging.

OBJECTIVES: The durability of bioprosthetic valves in the pulmonary position is suboptimal. The objectives of this study were to evaluate the early results of polytetrafluoroethylene (PTFE) bicuspid pulmonary valve (PV) implantation and to better define the function of this valve by magnetic resonance imaging (MRI). METHODS: Fifty-six patients who underwent PTFE bicuspid PV implantation between June 2009 and August 2011 were retrospectively analysed. The median age was 17.5 years and median valve size was 26 mm. Fundamental diagnoses were tetralogy of Fallot (n = 38), pulmonary atresia with ventricular septal defect (n = 8), double outlet right ventricle (n = 7) and absent PV syndrome (n = 3). Thirty-two patients with pulmonary regurgitation (PR) underwent MRI preoperatively and 22 of them underwent follow-up MRI at a median of 6.7 months postoperatively. RESULTS: There was one early death. Postoperative echocardiography (n = 53) showed no or trivial PR in 49 patients and mild PR in 4. Median follow-up duration was 15.2 months. There was no late death or reoperation. Follow-up echocardiography (n = 41) performed at a median of 7.5 months postoperatively showed no or trivial PR in 33 patients and mild PR in 8 patients. Follow-up MRI showed a significant reduction in right ventricular volumes and improvement in biventricular function. The median PR fraction of this valve was 10%. CONCLUSIONS: Early results of bicuspid PV implantation using PTFE membrane were satisfactory. PTFE bicuspid PV demonstrated excellent performance for the short term as evidenced by echocardiography and MRI. Long-term follow-up is mandatory to determine the durability of this valve.