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Polytetrafluoroethylene pulmonary valve conduit implantation for chronic pulmonary insufficiency*

Published online by Cambridge University Press:  29 December 2014

James A. Quintessenza
James A. Quintessenza*
Affiliation:
Johns Hopkins All Children’s Heart Institute, Saint Petersburg, Florida, United States of America
*
Correspondence to: J. A. Quintessenza, MD, Johns Hopkins All Children’s Heart Institute, 601 Fifth Street South, Suite 607, Saint Petersburg, FL 33701, United States of America. Tel: +727 767 6666; Fax: +727 767 8606; E-mail: [email protected]
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Abstract

Pulmonary valve replacement in patients with congenital cardiac disease is now being performed with more liberal indications in light of the data that chronic pulmonary insufficiency is not a benign lesion. The beneficial effects of valve replacement with low operative mortality and morbidity support this approach. Many options exist for a pulmonary valve prosthesis, which underscores the fact that there is no ideal valve available. Our efforts are focussed around a synthetic valve that avoids the bio-degeneration of a bio-prosthesis and avoids the need for life-long coumadin. We developed a bicuspid (bileaflet) polytetrafluoroethylene valve design, which has now gone through three major revisions in >200 patients over 14 years. We began the experience utilising a polytetrafluoroethylene hand-sewn bicuspid valve in the right ventricular outflow tract, initially using 0.6 mm and more recently 0.1 mm polytetrafluoroethylene. The 0.1 mm thickness material functions well as a leaflet, maintaining a relatively thin and flexible nature. It does not calcify or initiate thromboses at least for the first several years. We identified issues with dehiscence of the leaflet from the right ventricular outflow tract muscle, especially in the larger, potentially expansive right ventricular outflow tracts, and this prompted our latest design change to place the valve within a polytetrafluoroethylene tube. This current version of the polytetrafluoroethylene valve conduit has excellent short-to-intermediate-term function. Further follow-up is necessary to determine late durability and life-long valve-related procedural risk for our patients.

Keywords

Pulmonary insufficiencypulmonary valve replacement
Type
Original Article
Information
Cardiology in the Young , Volume 24 , Issue 6: HeartWeek 2014 , December 2014 , pp. 1101 - 1103
Copyright
© Cambridge University Press 2014 

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Footnotes

*

Presented at the Johns Hopkins All Children’s Heart Institute, 14th Annual International Symposium on Congenital Heart Disease, Saint Petersburg, Florida, United States of America, 15–18 February, 2014.

References

1.Bouzas, B, Kilner, PJ, Gatzoulis, MA. Pulmonary regurgitation: not a benign lesion. Eur Heart J 2005; 26: 433–439.Google Scholar
2.Frigiola, A, Redington, AN, Cullen, S. Pulmonary regurgitation is an important determinant of right ventricular contractile dysfunction in patients with surgically repaired tetralogy of Fallot. Circulation 2004; 110 (Supp l): 153–157.CrossRefGoogle ScholarPubMed
3.Davroulos, PA, et al. Timing and type of surgery for severe pulmonary regurgitation late after repair of tetralogy of Fallot. Int J Cardiol 2004; 97: 91–101.Google Scholar
4.Bove, EL, Kavey, RE, Byrum, CJ, et al. Improved right ventricular function following late pulmonary valve replacement for residual pulmonary insufficiency or stenosis. J Thorac Cardiovasc Surg 1985; 90: 50–55.Google Scholar
5.Ammash, NM, Dearani, JA, Burkhart, HM, et al. Pulmonary regurgitation after tetralogy of Fallot: clinical features, sequelae, and timing of pulmonary valve replacement. Congenit Heart Dis 2007; 2 386–403.CrossRefGoogle ScholarPubMed
6.Matsoukis, MA, Balladic, S, Webber, SA, et al.Risk factors for arrhythmia and sudden cardiac death late after repair of tetralogy of Fallot: a multicenter study. Lancet 2000; 356: 975–981.Google Scholar
7.Vliegen, HW, Van Straten, A, de Roos, A, et al.Magnetic resonance imaging to assess the hemodynamic effects of pulmonary valve replacement in adults late after repair of tetralogy of Fallot. Circulation 2002; 106: 1703–1707.Google Scholar
8.Therrien, J, Siu, SC, McLaughlin, PR, Liu, PP, Williams, WG, Webb, GD. Pulmonary valve replacement in adults late after repair of tetralogy of Fallot: are we operating too late? J Am Coll Cardiol 2000; 36: 1670–1675.Google Scholar
9.Therrien, J, Siu, SC, Harris, L, et al. Impact of pulmonary valve replacement on arrhythmia propensity late after repair of tetralogy of Fallot. Circulation 2001; 103: 2489–2494.Google Scholar
10.Hawkins, JA, Sower, CT, Lambert, LM, et al.Stentless porcine valves in the right ventricular outflow tract: improved durability. Eur J Cardiothorac Surg 2009; 35: 600–604; discussion 604–605. Epub February 10, 2009.Google Scholar
11.Kanter, KR, Budde, JM, Parks, WJ, et al. One hundred pulmonary valve replacements in children after relief of right ventricular outflow tract obstruction. Ann Thorac Surg 2002; 73: 1801–1806; discussion 1806–1807.Google Scholar
12.Fiore, AC, Rodefeld, M, Turrentine, M, et al. Pulmonary valve replacement: comparison of three biologic valves. Ann Thorac Surg 2008; 85: 1712–1718.Google Scholar
13.Hawkins, JA, Breinholt, JP, Lambert, LM, et al.Class I and class II anti-HLA antibodies after implantation of cryopreserved allograft material in pediatric patients. J Thorac Cardiovasc Surg 2000; 119: 324–330.Google Scholar
14.Toshiharu, S, Dominique, ST, Peter, X. Creation of viable pulmonary artery autografts through tissue engineering. J Thorac Cardiovasc Surg 1998; 115: 536–546.Google Scholar
15.Waterbolk, TW, Hoendermis, ES, den Hamer, IJ, Ebels, T. Pulmonary valve replacement with a mechanical prosthesis. Promising results of 28 procedures in patients with congenital heart disease. Eur J Cardiothorac Surg 2006; 30: 28–32.Google Scholar
16.Turrentine, MW, McCarthy, RP, Vijay, P, McConnell, KW, Brown, JW. PTFE monocusp valve reconstruction of the right ventricular outflow tract. Ann Thorac Surg 2002; 73: 871–880.Google Scholar
17.Quintessenza, JA, Jacobs, JP, Chai, PJ, Morell, VO, Giroud, JM, Boucek, RJ. Late replacement of the pulmonary valve: when and what type of valve? In 2005 Supplement to Cardiology in the Young: Controversies of the Ventriculo-Arterial Junctions and Other Topics, Jacobs JP, Wernovsky G, Gaynor JW, and Anderson RH, editors. Cardiology in the Young. 2005 Feb; 15(Suppl 1):58-63.Google Scholar
18.Quintessenza, JA, Jacobs, JP, Morell, VO, Giroud, JM, Boucek, RJ. The Initial Experience with a Bicuspid Polytetrafluoroethylene Pulmonary Valve in 41 Children and Adults: A New Option for Right Ventricular Outflow Tract Reconstruction. Ann Thorac Surg 2005 Mar79 (3): 924–931.CrossRefGoogle ScholarPubMed
19.Quintessenza, JA, Jacobs, JP, Chai, PJ, Morell, VO, Lindberg, H. Polytetrafluoroethylene Bicuspid Pulmonary Valve Implantation: Experience With 126 Patients. World Journal for Pediatric and Congenital Heart Surgery 2010 April; 1: 20–27.Google Scholar
20.Lee, C, Jacobs, JP, Lee, CH, Kwak, JG, Chai, PJ, Quintessenza, JA. Surgical pulmonary valve insertion - when, how, and why. Cardiol Young. 2012 Dec22 (6): 702–707; PMID: 23331591.Google Scholar
21.Dearani, JA, Connolly, HM, Martinez, R, Fontanet, H, Webb, GD. Caring for adults with congenital heart disease: successes and challenges for 2007 and beyond. Cardiol Young 2007 Sep17 (Suppl 2): 87–96; Review. PMID: 18039402.Google Scholar
22.Dearani, JA, Mavroudis, C, Quintessenza, J, Deal, BJ, Backer, CL, Fitzgerald, P, Connolly, HM, Jacobs, JP.. Surgical advances in the treatment of adults with congenital heart disease. Curr Opin Pediatr 2009 Oct21 (5): 565–572; doi: 10.1097/MOP.0b013e3283303fa7. PMID: 19745740.Google Scholar
23.Frigiola, A, Nordmeyer, J, Bonhoeffer, P, et al. Percutaneous pulmonary valve replacement. Coron Artery Dis 2009; 20: 189–191.Google Scholar
24.Ringewald, JM, Suh, EJ. Transcatheter pulmonary valve insertion: when, how, and why. Cardiol Young. 2012 Dec22 (6): 696–701; doi: 10.1017/S1047951112001527. Review. PMID: 23331590.Google Scholar
25.Ringewald, JM, Suh, EJ. Transcatheter pulmonary valve insertion, expanded use and future directions. Cardiol Young. 2013 Dec23 (6): 910–914; doi: 10.1017/S1047951113001728. PMID: 24401266.Google Scholar
26.Martinez, RM, Ringewald, JM, Fontanet, HL, Quintessenza, JA, Jacobs, JP.. Management of adults with Tetralogy of Fallot. Cardiol Young. 2013 Dec23 (6): 921–932; doi: 10.1017/S1047951113001741. PMID: 24401268.Google Scholar