Division of Cardiovascular Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
Interact Cardiovasc Thorac Surg. 2021 Apr 19;32(4):585-592. doi: 10.1093/icvts/ivaa302.
Many surgeons develop unique techniques for unmet needs for right ventricular outflow reconstruction to resolve pulmonary regurgitation after corrective surgery for congenital heart diseases. Expanded polytetrafluoroethylene (ePTFE) stands out as a reliable synthetic material, and clinical results with handmade ePTFE valves have been promising. This review focuses on the historical evolution of the use of ePTFE in pulmonary valve replacement and in the techniques for pioneering the translation of the handmade ePTFE trileaflet design for the transcatheter approach.
We searched for and reviewed publications from 1990 to 2020 in the Pubmed database. Nineteen clinical studies from 2005 to 2019 that focused on ePTFE-based valves were summarized. The evolution of the ePTFE-based valve over 3 decades and recent relevant in vitro studies were investigated.
The average freedom from reintervention or surgery in the recorded ePTFE-based valve population was 90.2% at 5 years, and the survival rate was 96.7% at 3 years.
Non-inferior clinical results of this ePTFE handmade valve were revealed compared to allograft or xenograft options for pulmonary valve replacement. Future investigations on transferring ePTFE trileaflet design to transcatheter devices should be considered.
许多外科医生为满足右心室流出道重建的未满足需求而开发独特技术，以解决先天性心脏病矫正手术后的肺瓣反流问题。膨体聚四氟乙烯（ePTFE）作为一种可靠的合成材料脱颖而出，手工 ePTFE 瓣的临床结果很有前景。本综述重点介绍了 ePTFE 在肺动脉瓣置换中的历史演变，以及将手工 ePTFE 三叶瓣设计转化为经导管方法的开创性技术。
我们在 Pubmed 数据库中搜索并回顾了 1990 年至 2020 年的出版物。总结了 2005 年至 2019 年的 19 项聚焦于基于 ePTFE 的瓣膜的临床研究。研究了 ePTFE 瓣膜在 30 多年间的演变和最近相关的体外研究。
在记录的基于 ePTFE 的瓣膜人群中，平均无再干预或手术率在 5 年内为 90.2%，3 年内生存率为 96.7%。
与同种异体或异种移植物的肺动脉瓣置换选择相比，这种 ePTFE 手工瓣膜的临床结果具有非劣效性。应考虑将 ePTFE 三叶瓣设计转移到经导管器械上的未来研究。
