Modification of expanded polytetrafluoroethylene valved conduit using the thin-type leaflets
Modification of expanded polytetrafluoroethylene valved conduit using the thin-type leaflets
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DOI：
10.1016/j.jtcvs.2018.04.107
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发表时间：
2018-10-01
影响因子：
6
通讯作者：
Kado, Hideaki
中科院分区：
文献类型：
--
作者：
Yamamoto, Yusuke;Yamagishi, Masaaki;Kado, Hideaki
目的：采用新型薄型聚四氟乙烯瓣叶，改进了用于右室流出道重建的扇形瓣叶和窦状隆起的聚四氟乙烯导管。方法：自2010年1月至2013年12月，对149例右室流出道重建患者行改良聚四氟乙烯导管重建术;将55例接受传统管道的患者（N组）与94例接受改良管道的患者（T组）进行比较。没有与导管相关的死亡、手术死亡或因导管故障而重新植入。N组和T组的3年总生存率和无再干预率分别为98.2%和95.6%（P = .438），94.7%和97.9%（P = .954）。平均峰值压差分别为22.6 +/- 15.6 mm Hg和18.2 +/- 11.5 mm Hg（P = 0.161），在小尺寸管道内的子分析中，分别为30.2 +/- 16.5 mm Hg和20.4 +/- 10.7 mm Hg（P = 0.034）。关于导管功能不全，改良导管显示出明显更差的功能不全等级（P = 0.014）仅在大尺寸管道内的亚组分析中。虽然中期观察的临床结局没有差异，但认为薄型膨胀聚四氟乙烯瓣叶适用于小尺寸管道，而不适用于大尺寸管道，基于血流动力学性能的比较。长期随访是必要的，以解决适当的片材类型的中型管道和估计的耐用性薄型瓣叶。
Objectives: The expanded polytetrafluoroethylene conduit with fan-shaped leaflets and bulging sinuses for right ventricular outflow tract reconstruction was modified with a newly developed thin-type expanded polytetrafluoroethylene leaflet. The purpose of this study was to evaluate the clinical outcomes and hemodynamic performance of the modified conduit.Methods: From January 2010 to December 2013, 149 patients underwent definitive right ventricular outflow tract reconstruction using the expanded polytetrafluoroethylene conduit; the 55 patients receiving a conventional conduit (group N) were compared with the 94 patients receiving a modified conduit (group T).Results: There were no conduit-related deaths, operative deaths, or reimplantations for conduit failure. The overall survival and freedom from reintervention for conduit-related reasons at 3 years were 98.2% versus 95.6% (P = .438) and 94.7% versus 97.9% (P = .954) for groups N and T, respectively. The mean peak pressure gradients were 22.6 +/- 15.6 mm Hg versus 18.2 +/- 11.5 mm Hg (P = .161), and in the subanalysis within small-sized conduits, they were 30.2 +/- 16.5 mm Hg versus 20.4 +/- 10.7 mm Hg (P = .034). Regarding conduit insufficiency, the modified conduit showed a significantly worse grade of insufficiency (P = .014) only in the subanalysis within large-sized conduits.Conclusions: Although the clinical outcomes did not differ within midterm observation, the thin-type expanded polytetrafluoroethylene leaflet was considered to be suitable for the small-sized conduits, but not for large-sized conduits, based on the comparison of the hemodynamic performance. Long-term followup is necessary to address the appropriate sheet type for middle-sized conduits and to estimate the durability of the thin-type leaflet.