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Right Ventricular Outflow Tract Reconstruction With a Polytetrafluoroethylene Monocusp Valve: A 20-Year Experience.
Semin Thorac Cardiovasc Surg. 2016 Summer; 28(2):463-470.ST

Abstract

In patients with tetralogy of Fallot (TOF), pulmonary atresia (PA), and other congenital right ventricular outflow tract (RVOT) malformations, polytetrafluoroethylene (PTFE) monocusp outflow tract patches (MOTP) relieve obstruction and provide pulmonary valve competence. The purpose of this study was to determine whether our PTFE-MOTP was an acceptable short- and mid-term remedy for patients with TOF or PA as assessed by freedom from severe pulmonary regurgitation and freedom from reoperation. From 1994-2014, 171 patients (mean age 1.5 ± 1.5 years; median 1.1 years) with TOF or PA underwent initial right ventricular outflow tract (RVOT) reconstruction with a PTFE-MOTP. Patients were studied intraoperatively and serially postoperatively using echocardiography and cardiac magnetic resonance imaging (CMR) to determine pulmonary valve dysfunction defined as a peak gradient >40mmHg or valve regurgitation>moderate. The mean follow-up duration was 10.9 ± 5.8 years (range: 1 month-20 years). There were 5 late deaths and 1 early death. There was a significant difference between the preoperative and postoperative peak RVOT gradients (74.0 vs 25.2mmHg). Of the 171 patients, 25 were lost to follow-up, and 42 have required replacement of their monocusp valves 10.1 ± 5.0 years (range: 5 months-19 years) after original monocusp insertion. At 10-year follow-up, severe pulmonary regurgitation was seen in less than 25% of patients, and severe pulmonary stenosis was seen in less than 10% of patients. Since 2007, CMR was used in 44 patients to characterize cardiac function in patients under consideration for PTFE-MOTP replacement. The average right ventricular-to-left ventricular (RV/LV) ratio on CMR was 1.7 ± 0.5 in these patients. CMR also showed that RV ejection fraction (52 ± 9%) and left ventricular ejection fraction (58 ± 7%) were both preserved in most patients. The PTFE-MOTP is an excellent short-term and mid-term option for initial RVOT reconstruction, particularly in children with TOF with nonsalvageable pulmonary valve or PA-ventricular septal defect.

Authors+Show Affiliations

Section of Cardiothoracic Surgery, Department of Surgery, James Whitcomb Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana.Section of Cardiothoracic Surgery, Department of Surgery, James Whitcomb Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana.Section of Cardiothoracic Surgery, Department of Surgery, James Whitcomb Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana.Section of Cardiothoracic Surgery, Department of Surgery, James Whitcomb Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana.Section of Cardiothoracic Surgery, Department of Surgery, James Whitcomb Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana. Electronic address: jobrown@iupui.edu.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

28043462

Citation

Kumar, Mohineesh, et al. "Right Ventricular Outflow Tract Reconstruction With a Polytetrafluoroethylene Monocusp Valve: a 20-Year Experience." Seminars in Thoracic and Cardiovascular Surgery, vol. 28, no. 2, 2016, pp. 463-470.
Kumar M, Turrentine MW, Rodefeld MD, et al. Right Ventricular Outflow Tract Reconstruction With a Polytetrafluoroethylene Monocusp Valve: A 20-Year Experience. Semin Thorac Cardiovasc Surg. 2016;28(2):463-470.
Kumar, M., Turrentine, M. W., Rodefeld, M. D., Bell, T., & Brown, J. W. (2016). Right Ventricular Outflow Tract Reconstruction With a Polytetrafluoroethylene Monocusp Valve: A 20-Year Experience. Seminars in Thoracic and Cardiovascular Surgery, 28(2), 463-470. https://doi.org/10.1053/j.semtcvs.2016.05.003
Kumar M, et al. Right Ventricular Outflow Tract Reconstruction With a Polytetrafluoroethylene Monocusp Valve: a 20-Year Experience. Semin Thorac Cardiovasc Surg. 2016 Summer;28(2):463-470. PubMed PMID: 28043462.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Right Ventricular Outflow Tract Reconstruction With a Polytetrafluoroethylene Monocusp Valve: A 20-Year Experience. AU - Kumar,Mohineesh, AU - Turrentine,Mark W, AU - Rodefeld,Mark D, AU - Bell,Teresa, AU - Brown,John W, Y1 - 2016/06/02/ PY - 2016/05/26/accepted PY - 2017/1/4/entrez PY - 2017/1/4/pubmed PY - 2017/6/14/medline KW - Gore-tex Monocusp. KW - Left-Systole KW - Right-Diastole SP - 463 EP - 470 JF - Seminars in thoracic and cardiovascular surgery JO - Semin Thorac Cardiovasc Surg VL - 28 IS - 2 N2 - In patients with tetralogy of Fallot (TOF), pulmonary atresia (PA), and other congenital right ventricular outflow tract (RVOT) malformations, polytetrafluoroethylene (PTFE) monocusp outflow tract patches (MOTP) relieve obstruction and provide pulmonary valve competence. The purpose of this study was to determine whether our PTFE-MOTP was an acceptable short- and mid-term remedy for patients with TOF or PA as assessed by freedom from severe pulmonary regurgitation and freedom from reoperation. From 1994-2014, 171 patients (mean age 1.5 ± 1.5 years; median 1.1 years) with TOF or PA underwent initial right ventricular outflow tract (RVOT) reconstruction with a PTFE-MOTP. Patients were studied intraoperatively and serially postoperatively using echocardiography and cardiac magnetic resonance imaging (CMR) to determine pulmonary valve dysfunction defined as a peak gradient >40mmHg or valve regurgitation>moderate. The mean follow-up duration was 10.9 ± 5.8 years (range: 1 month-20 years). There were 5 late deaths and 1 early death. There was a significant difference between the preoperative and postoperative peak RVOT gradients (74.0 vs 25.2mmHg). Of the 171 patients, 25 were lost to follow-up, and 42 have required replacement of their monocusp valves 10.1 ± 5.0 years (range: 5 months-19 years) after original monocusp insertion. At 10-year follow-up, severe pulmonary regurgitation was seen in less than 25% of patients, and severe pulmonary stenosis was seen in less than 10% of patients. Since 2007, CMR was used in 44 patients to characterize cardiac function in patients under consideration for PTFE-MOTP replacement. The average right ventricular-to-left ventricular (RV/LV) ratio on CMR was 1.7 ± 0.5 in these patients. CMR also showed that RV ejection fraction (52 ± 9%) and left ventricular ejection fraction (58 ± 7%) were both preserved in most patients. The PTFE-MOTP is an excellent short-term and mid-term option for initial RVOT reconstruction, particularly in children with TOF with nonsalvageable pulmonary valve or PA-ventricular septal defect. SN - 1532-9488 UR - https://www.unboundmedicine.com/medline/citation/28043462/Right_Ventricular_Outflow_Tract_Reconstruction_With_a_Polytetrafluoroethylene_Monocusp_Valve:_A_20_Year_Experience_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1043-0679(16)30047-8 DB - PRIME DP - Unbound Medicine ER -