Application of pulmonary valve reconstruction technology in right ventricular outflow tract reconstruction_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHANG Yong , XU Gang , WEN Shusheng , CEN Jianzheng , CUI Hujun , LIU Xiaobing ,  ZHUANG Jian ,  CHEN Jimei

Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academic of Medical Science, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangzhou, 510100, P.R.China;

Corresponding author：

ZHUANG Jian, Email: drzhuangjian5413@163.com; CHEN Jimei, Email: jimei1965@gmail.com

Keywords：

Artificial pulmonary valve reconstruction technology; right ventricular outflow tract reconstruction; pulmonary valve regurgitation

DOI：

10.7507/1007-4848.201802031

Video：

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Objective To evaluate possibility and reliability of the technique of artificial pulmonary valve reconstruction in right ventricular outflow tract reconstruction. Methods We retrospectively analyzed the clinical data of 35 patients with artificial pulmonary valve reconstruction of right ventricular outflow tract reconstruction surgery in our hospital between February 2012 and December 2016. There were 35 patients with 19 males and 16 females at age of 10 years ranged 5 months to 42 years and body weight of 26 (8–62) kg. There were 21 patients with artificial moncusp valve, 6 patients with bicuspid technology, 8 patients with comprehensive forming method. Results Average extracorporeal circulation time was 75–251 (120±37) min. Aorta blocking time was 32–185 (72±28) min. ICU stay time was 14–225 (59±51) hours. Breathing machine auxiliary time was 6–68 (24±18) hours. There were 3 early postoperative deaths. There was no death during the long term following-up time. Thirty-two patients survived with heart function of class Ⅰ in 20 patients, class Ⅱ in 10 patients, class Ⅲ in 2 patients. Conclusion In right ventricular outflow tract reconstruction using the technique of artificial pulmonary valve reconstruction in the operation, it can reduce early postoperative right ventricular volume load. To smooth out perioperative patients, the surgical technique is simple, cheap, safe, but long-term follow-up still needs further observation.

Citation： ZHANG Yong, XU Gang, WEN Shusheng, CEN Jianzheng, CUI Hujun, LIU Xiaobing, ZHUANG Jian, CHEN Jimei. Application of pulmonary valve reconstruction technology in right ventricular outflow tract reconstruction. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2018, 25(12): 1049-1053. doi: 10.7507/1007-4848.201802031 Copy

1.	Göber V, Berdat P, Pavlovic M, et al. Adverse mid-term outcome following RVOT reconstruction using the Contegra valved bovine jugular vein. Ann Thorac Surg, 2005, 79(2): 625-631.
2.	He GW. A new technique of transannular monocusp patch-repair of the right ventricular outflow tract in repair of tetralogy of Fallot. Heart Lung Circ, 2007, 16(2): 107-112.
3.	Reyes KG, Cuaso CC, Tan RB. Double-barrel right ventricular outflow: tetralogy of Fallot annulus preservation technique. Ann Thorac Surg, 2012, 94(3): 1023-1025.
4.	Kalfa D, Bel A, Chen-Tournoux A, et al. A polydioxanone electrospun valved patch to replace the right ventricular outflow tract in a growing lamb model. Biomaterials, 2010, 31(14): 4056-4063.
5.	Quintessenza JA, Jacobs JP, Morell VO, et al. Initial experience with a bicuspid polytetrafluoroethylene pulmonary valve in 41 children and adults: a new option for right ventricular outflow tract reconstruction. Ann Thorac Surg, 2005, 79(3): 924-931.
6.	Lee C, Kim YM, Lee CH, et al. Outcomes of pulmonary valve replacement in 170 patients with chronic pulmonary regurgitation after relief of right ventricular outflow tract obstruction: implications for optimal timing of pulmonary valve replacement. J Am Coll Cardiol, 2012, 60(11): 1005-1014.
7.	Turrentine MW, McCarthy RP, Vijay P, et al. PTFE monocusp valve reconstruction of the right ventricular outflow tract. Ann Thorac Surg, 2002, 73(3): 871-879.
8.	Turrentine MW, McCarthy RP, Vijay P, et al. Polytetrafluoroethylene monocusp valve technique for right ventricular outflow tract reconstruction. Ann Thorac Surg, 2002, 74(6): 2202-2205.
9.	Luo QZ, Lin L, Gong Z, et al. Positive association of major histocompatibility complex class I chain-related gene A polymorphism with leukemia susceptibility in the people of Han nationality of Southern China. Tissue Antigens, 2011, 78(3): 178-184.
10.	Nath DS, Nussbaum DP, Yurko C, et al. Pulmonary homograft monocusp reconstruction of the right ventricular outflow tract: outcomes to the intermediate term. Ann Thorac Surg, 2010, 90(1): 42-49.
11.	Ootaki Y, Welch AS, Walsh MJ, et al. Medium-term outcomes after implantation of expanded polytetrafluoroethylene valved conduit. Ann Thorac Surg, 2018, 105(3): 843-850.
12.	Lee C, Lee CH, Kwak JG, et al. Bicuspid pulmonary valve implantation using polytetrafluoroethylene membrane: early results and assessment of the valve function by magnetic resonance imaging. Eur J Cardiothorac Surg, 2013, 43(3): 468-472.
13.	Lee C, Lee CH, Kwak JG. Polytetrafluoroethylene bicuspid pulmonary valve replacement: A 5-year experience in 119 patients with congenital heart disease. Ann Thorac Surg, 2016, 102(1): 163-169.
14.	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.
15.	Bacha E. Valve-sparing or valve reconstruction options in tetralogy of Fallot surgery. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu, 2017, 20: 79-83.
16.	Brown JW, Ruzmetov M, Rodefeld MD, et al. Valved bovine jugular vein conduits for right ventricular outflow tract reconstruction in children: an attractive alternative to pulmonary homograft. Ann Thorac Surg, 2006, 82(3): 909-916.
17.	Ando M, Takahashi Y. Ten-year experience with handmade trileaflet polytetrafluoroethylene valved conduit used for pulmonary reconstruction. J Thorac Cardiovasc Surg, 2009, 137(1): 124-131.
18.	Belli E, Salihoğlu E, Leobon B, et al. The performance of Hancock porcine-valved Dacron conduit for right ventricular outflow tract reconstruction. Ann Thorac Surg, 2010, 89(1): 152-157.
19.	Gil-Jaurena JM, Ferreiros M, Castillo R, et al. Use of a pulmonary neovalve with a transannular patch for repair of tetralogy of fallot. Rev Esp Cardiol, 2010, 63(12): 1438-1443.
20.	Salem AM. Right ventricle to pulmonary artery connection: Evolution and current alternatives. J Egypt Soc Cardio-Thorac Surg, 2016, 24(1): 47-57.
21.	Brown JW, Ruzmetov M, Vijay P, et al. Right ventricular outflow tract reconstruction with a polytetrafluoroethylene monocusp valve: a twelve-year experience. J Thorac Cardiovasc Surg, 2007, 133(5): 1336-1343.
22.	Papadopoulos N, Esmaeili A, Zierer A, et al. Secondary repair of incompetent pulmonary valves. Ann Thorac Surg, 2009, 87(6): 1879-1884.
23.	Bove T, François K, De Wolf D. New insights into the surgical management of tetralogy of Fallot: physiological fundamentals and clinical relevance. Curr Pediatr Rev, 2015, 11(2): 72-86.
24.	Geva T, Gauvreau K, Powell AJ, et al. Randomized trial of pulmonary valve replacement with and without right ventricular remodeling surgery. Circulation, 2010, 122: 5201-5208.
25.	Tweddell JS, Simpson P, Li SH, et al. Timing and technique of pulmonary valve replacement in the patient with tetralogy of Fallot. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu, 2012, 15(1): 27-33.
26.	Hallbergson A, Gauvreau K, Powell AJ, et al. Right ventricular remodeling after pulmonary valve replacement: early gains, late losses. Ann Thorac Surg, 2015, 99(2): 660-666.
27.	Valente AM, Gauvreau K, Assenza GE, et al. Contemporary predictors of death and sustained ventricular tachycardia in patients with repaired tetralogy of Fallot enrolled in the indicator cohort. Heart, 2014, 100(3): 247-253.
28.	Cheatham JP, Hellenbrand WE, Zahn EM, et al. Clinical and hemodynamic outcomes up to 7 years after transcatheter pulmonary valve replacement in the US Melody Valve Investigational Device Exemption Trial. Circulation, 2015, 131(22): 1960-1970.
29.	Kogon BE, Rosenblum JM, Mori M. Current readings: issues surrounding pulmonary valve replacement in pediatric cardiac disease: a scientific statement from the American Heart Association. Circulation, 2011, 123: 2607-2652.

1. Göber V, Berdat P, Pavlovic M, et al. Adverse mid-term outcome following RVOT reconstruction using the Contegra valved bovine jugular vein. Ann Thorac Surg, 2005, 79(2): 625-631.
2. He GW. A new technique of transannular monocusp patch-repair of the right ventricular outflow tract in repair of tetralogy of Fallot. Heart Lung Circ, 2007, 16(2): 107-112.
3. Reyes KG, Cuaso CC, Tan RB. Double-barrel right ventricular outflow: tetralogy of Fallot annulus preservation technique. Ann Thorac Surg, 2012, 94(3): 1023-1025.
4. Kalfa D, Bel A, Chen-Tournoux A, et al. A polydioxanone electrospun valved patch to replace the right ventricular outflow tract in a growing lamb model. Biomaterials, 2010, 31(14): 4056-4063.
5. Quintessenza JA, Jacobs JP, Morell VO, et al. Initial experience with a bicuspid polytetrafluoroethylene pulmonary valve in 41 children and adults: a new option for right ventricular outflow tract reconstruction. Ann Thorac Surg, 2005, 79(3): 924-931.
6. Lee C, Kim YM, Lee CH, et al. Outcomes of pulmonary valve replacement in 170 patients with chronic pulmonary regurgitation after relief of right ventricular outflow tract obstruction: implications for optimal timing of pulmonary valve replacement. J Am Coll Cardiol, 2012, 60(11): 1005-1014.
7. Turrentine MW, McCarthy RP, Vijay P, et al. PTFE monocusp valve reconstruction of the right ventricular outflow tract. Ann Thorac Surg, 2002, 73(3): 871-879.
8. Turrentine MW, McCarthy RP, Vijay P, et al. Polytetrafluoroethylene monocusp valve technique for right ventricular outflow tract reconstruction. Ann Thorac Surg, 2002, 74(6): 2202-2205.
9. Luo QZ, Lin L, Gong Z, et al. Positive association of major histocompatibility complex class I chain-related gene A polymorphism with leukemia susceptibility in the people of Han nationality of Southern China. Tissue Antigens, 2011, 78(3): 178-184.
10. Nath DS, Nussbaum DP, Yurko C, et al. Pulmonary homograft monocusp reconstruction of the right ventricular outflow tract: outcomes to the intermediate term. Ann Thorac Surg, 2010, 90(1): 42-49.
11. Ootaki Y, Welch AS, Walsh MJ, et al. Medium-term outcomes after implantation of expanded polytetrafluoroethylene valved conduit. Ann Thorac Surg, 2018, 105(3): 843-850.
12. Lee C, Lee CH, Kwak JG, et al. Bicuspid pulmonary valve implantation using polytetrafluoroethylene membrane: early results and assessment of the valve function by magnetic resonance imaging. Eur J Cardiothorac Surg, 2013, 43(3): 468-472.
13. Lee C, Lee CH, Kwak JG. Polytetrafluoroethylene bicuspid pulmonary valve replacement: A 5-year experience in 119 patients with congenital heart disease. Ann Thorac Surg, 2016, 102(1): 163-169.
14. 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.
15. Bacha E. Valve-sparing or valve reconstruction options in tetralogy of Fallot surgery. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu, 2017, 20: 79-83.
16. Brown JW, Ruzmetov M, Rodefeld MD, et al. Valved bovine jugular vein conduits for right ventricular outflow tract reconstruction in children: an attractive alternative to pulmonary homograft. Ann Thorac Surg, 2006, 82(3): 909-916.
17. Ando M, Takahashi Y. Ten-year experience with handmade trileaflet polytetrafluoroethylene valved conduit used for pulmonary reconstruction. J Thorac Cardiovasc Surg, 2009, 137(1): 124-131.
18. Belli E, Salihoğlu E, Leobon B, et al. The performance of Hancock porcine-valved Dacron conduit for right ventricular outflow tract reconstruction. Ann Thorac Surg, 2010, 89(1): 152-157.
19. Gil-Jaurena JM, Ferreiros M, Castillo R, et al. Use of a pulmonary neovalve with a transannular patch for repair of tetralogy of fallot. Rev Esp Cardiol, 2010, 63(12): 1438-1443.
20. Salem AM. Right ventricle to pulmonary artery connection: Evolution and current alternatives. J Egypt Soc Cardio-Thorac Surg, 2016, 24(1): 47-57.
21. Brown JW, Ruzmetov M, Vijay P, et al. Right ventricular outflow tract reconstruction with a polytetrafluoroethylene monocusp valve: a twelve-year experience. J Thorac Cardiovasc Surg, 2007, 133(5): 1336-1343.
22. Papadopoulos N, Esmaeili A, Zierer A, et al. Secondary repair of incompetent pulmonary valves. Ann Thorac Surg, 2009, 87(6): 1879-1884.
23. Bove T, François K, De Wolf D. New insights into the surgical management of tetralogy of Fallot: physiological fundamentals and clinical relevance. Curr Pediatr Rev, 2015, 11(2): 72-86.
24. Geva T, Gauvreau K, Powell AJ, et al. Randomized trial of pulmonary valve replacement with and without right ventricular remodeling surgery. Circulation, 2010, 122: 5201-5208.
25. Tweddell JS, Simpson P, Li SH, et al. Timing and technique of pulmonary valve replacement in the patient with tetralogy of Fallot. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu, 2012, 15(1): 27-33.
26. Hallbergson A, Gauvreau K, Powell AJ, et al. Right ventricular remodeling after pulmonary valve replacement: early gains, late losses. Ann Thorac Surg, 2015, 99(2): 660-666.
27. Valente AM, Gauvreau K, Assenza GE, et al. Contemporary predictors of death and sustained ventricular tachycardia in patients with repaired tetralogy of Fallot enrolled in the indicator cohort. Heart, 2014, 100(3): 247-253.
28. Cheatham JP, Hellenbrand WE, Zahn EM, et al. Clinical and hemodynamic outcomes up to 7 years after transcatheter pulmonary valve replacement in the US Melody Valve Investigational Device Exemption Trial. Circulation, 2015, 131(22): 1960-1970.
29. Kogon BE, Rosenblum JM, Mori M. Current readings: issues surrounding pulmonary valve replacement in pediatric cardiac disease: a scientific statement from the American Heart Association. Circulation, 2011, 123: 2607-2652.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Application of pulmonary valve reconstruction technology in right ventricular outflow tract reconstruction

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