Evolution of pulmonary valve reconstruction with focused review of expanded polytetrafluoroethylene handmade valves

Abstract

Objectives: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Keywords: Expanded polytetrafluoroethylene valve; Handmade pulmonary valve; Pulmonary transcatheter device; Pulmonary valve replacement.

Figure 1:

Images of expanded polytetrafluoroethylene (ePTFE) and operative illustration. (A) ePTFE monocusp on pericardial patch (left column) and ePTFE side-by-side bicuspid fashion (right column) by Yamagishi and Kurosawa [16] (B) Bicuspid ePTFE valve ‘bishop’s hat’ in opposite direction by Quintessenza et al. [22] The figures have been reproduced and modified with permission from the publisher.

Figure 2:

Operative illustrations for expanded polytetrafluoroethylene (ePTFE) trileaflet conduits. (A) Folded ePTFE trileaflet valve sewn in a Dacron tube by Ando and Takahashi [21] (B) Fan-shaped ePTFE trileaflet with bulging sinuses by Miyazaki et al. [23] The figures have been reproduced and modified with permission from the publisher.

Figure 3:

Operative illustrations for making valved stent graft. (A) Flip-over method for creating expanded polytetrafluoroethylene (ePTFE) trileaflet valved conduit by Chang and Chang [41] (B) Same concept for creating an ePTFE valved stent graft, which can be reloaded into a catheter for transcatheter pulmonary valve replacement by Chang et al. [52] These figures have been reproduced and modified with permission from the publishers.