Çiçek Murat, Özdemir Fatih, Yurdakök Okan, Korun Oktay, Önalan Mehmet Akif, Hekim Yılmaz Emine, Kudsioğlu Türkan, Aydemir Numan Ali
Department of Pediatric Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul 34668, Turkey.
Department of Cardiovascular Surgery, Faculty of Medicine Istanbul, Istanbul University-Cerrahpaşa, Istanbul 34320, Turkey.
J Clin Med. 2025 Mar 13;14(6):1957. doi: 10.3390/jcm14061957.
In this study, we present our early and mid-term results using two different types of handmade polytetrafluoroethylene (PTFE) valved conduits in patients who require right ventricular outflow reconstruction. Between March 2021 and May 2024, 72 patients (30 males and 42 females; median age: 69 (IQR: 26-123) months) who underwent implantation of a handmade bicuspid or tricuspid valve PTFE conduit for right ventricular outflow reconstruction were retrospectively analyzed. Preoperative, postoperative, and follow-up echocardiograms were also evaluated. The first postoperative echocardiography revealed that 11 (36.7%) patients had mild regurgitation, and 3 (10%) patients had moderate regurgitation in the bicuspid group initially, while only 7 (16.7%) of the patients in the tricuspid group had mild regurgitation ( = 0.004). None of the patients required reintervention in the early postoperative period because of conduit dysfunction. In the mid-term follow-up, the mean follow-up duration was 22.4 ± 11 months. PTFE-valved conduit dysfunction was observed in three patients in the bicuspid group, while no dysfunction was observed in the tricuspid group ( = 0.049). Even if the median peak gradient was found to be slightly higher in the tricuspid group [15 (IQR: 0-25) vs. 0 (IQR: 0-15)] ( = 0.032), no conduit dysfunction was reported during follow-up. Kaplan-Meier analysis demonstrated that the tricuspid conduit group maintained 100% freedom from dysfunction during the 24-month follow-up period. In contrast, the bicuspid group had rates of 90%, 87%, and 83% at 6, 12, and 24 months, respectively (log-rank = 0.016). The ePTFE valved conduits provide significant advantages in terms of durability, biocompatibility, cost-effectiveness, and hemodynamic performance for right ventricular outflow tract reconstruction in pediatric cardiac surgery. The findings of our study suggest that tricuspid valve design offers better potential for preventing conduit dysfunction.
在本研究中，我们展示了在需要右心室流出道重建的患者中使用两种不同类型的手工制作的聚四氟乙烯（PTFE）带瓣管道的早期和中期结果。在2021年3月至2024年5月期间，对72例（30例男性和42例女性；中位年龄：69（四分位间距：26 - 123）个月）接受手工制作的双叶或三叶瓣膜PTFE管道植入以进行右心室流出道重建的患者进行了回顾性分析。还评估了术前、术后和随访超声心动图。术后首次超声心动图显示，双叶瓣膜组最初有11例（36.7%）患者有轻度反流，3例（10%）患者有中度反流，而三叶瓣膜组仅有7例（16.7%）患者有轻度反流（P = 0.004）。术后早期没有患者因管道功能障碍需要再次干预。在中期随访中，平均随访时间为22.4 ± 11个月。双叶瓣膜组有3例患者观察到PTFE带瓣管道功能障碍，而三叶瓣膜组未观察到功能障碍（P = 0.049）。即使发现三叶瓣膜组的中位峰值压差略高[15（四分位间距：0 - 25）对0（四分位间距：0 - 15）]（P = 0.032），随访期间也未报告管道功能障碍。Kaplan - Meier分析表明，三叶瓣膜管道组在24个月的随访期内保持100%无功能障碍。相比之下，双叶瓣膜组在6个月、12个月和24个月时的无功能障碍率分别为90%、87%和83%（对数秩检验P = 0.016）。eptfe带瓣管道在小儿心脏手术中右心室流出道重建的耐久性、生物相容性、成本效益和血流动力学性能方面具有显著优势。我们的研究结果表明，三叶瓣膜设计在预防管道功能障碍方面具有更好的潜力。
