Initial experience with a bicuspid polytetrafluoroethylene pulmonary valve in 41 children and adults: a new option for right ventricular outflow tract reconstruction.

BACKGROUND: As the population of children with repaired congenital heart disease ages, an increasing number of patients will benefit from pulmonary valve insertion. We report our initial experience in 41 consecutive patients treated with placement of a surgically created polytetrafluoroethylene bicuspid pulmonary valve.

METHODS: A bicuspid pulmonary valve with orifice size greater than 24 mm is created with polytetrafluoroethylene and sutured into the right ventricular outflow tract. To obviate the need for reoperation in growing children, this technique is limited to older children and adults. Polytetrafluoroethylene bicuspid pulmonary valves were placed in 41 patients (age: range, 5.0 to 64.7 years, median = 15.7 years; weight: range, 14.2 to 99.0 kilograms, median, 52.0 kg). All patients had pulmonary insufficiency, pulmonary stenosis, or both, after previous intervention for tetralogy of Fallot (27), pulmonary stenosis (11), pulmonary atresia with intact ventricular septum (2), or double outlet right ventricle (1).

RESULTS: All patients left the operating theater with transesophageal echocardiography documenting no pulmonic stenosis and zero to trace pulmonic insufficiency. Median hospital length of stay was 5 days (range, 3 to 15 days; mean, 5.8 days). Follow-up including echocardiography ranged from 0.2 to 3.1 year (median follow-up, 1.5 years) and revealed significant improvement in New York Heart Association Classification, pulmonary insufficiency, and right ventricular end diastolic dimension.

CONCLUSIONS: Polytetrafluoroethylene bicuspid pulmonary valve reconstruction of the right ventricular outflow tract is a safe, effective, and durable technique for the short term. Appropriate oversizing minimizes outflow tract obstruction while maximizing competence. Long-term follow-up is necessary to determine the true value of this technique.