Key result
Trileaflet PTFE valved conduits maintain low pressure gradients and ~5% maximum regurgitation in mock circulation.
Why the study?
Handmade trileaflet expanded PTFE valved conduits show satisfactory outcomes in pulmonary valve reconstruction, but in vitro performance across various sizes and transformed into a transcatheter valve-in-valve stent graft system required investigation.
Handmade trileaflet polytetrafluoroethylene valved conduits and their valve-in-valve transformations demonstrate excellent in vitro hemodynamic performance, providing a reference for future transcatheter pulmonary valve research.
In vitro data support transcatheter valve-in-valve feasibility in handmade conduits; leaves open clinical translation pending in vivo validation.
OBJECTIVES: Handmade trileaflet expanded polytetrafluoroethylene valved conduit developed using the flip-over method has been tailored for pulmonary valve reconstruction with satisfactory outcomes. We investigated the in vitro performance of the valve design in a mock circulatory system with various conduit sizes. In our study, the design was transformed into a transcatheter stent graft system which could fit in original valved conduits in a valve-in-valve fashion. METHODS: Five different sizes of valved polytetrafluoroethylene vascular grafts (16, 18, 20, 22 and 24 mm) were mounted onto a mock circulatory system with a prism window for direct leaflets motion observation. Transvalvular pressure gradients were recorded using pressure transducers. Mean and instant flows were determined via a rotameter and a flowmeter. Similar flip-over trileaflet valve design was then carried out in 3 available stent graft sizes (23, 26 and 28.5 mm, Gore aortic extender), which were deployed inside the valved conduits. RESULTS: Peak pressure gradient across 5 different sized graft valves, in their appropriate flow setting (2.0, 2.5 and 5.0 l/min), ranged from 4.7 to 13.2 mmHg. No significant valve regurgitation was noted (regurgitant fraction: 1.6-4.9%) in all valve sizes and combinations. Three sizes of the trileaflet-valved stent grafts were implanted in the 4 sizes of valved conduits except for the 16-mm conduit. Peak pressure gradient increase after valved-stent graft-in-valved-conduit setting was <10 mmHg in all 4 conduits. CONCLUSIONS: The study showed excellent in vitro performance of trileaflet polytetrafluoroethylene valved conduits. Its valved stent graft transformation provided data which may serve as a reference for transcatheter valve-in-valve research in the future.
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Chang et al. (2019) studied Pulmonary valve reconstruction (in vitro model). Trileaflet expanded polytetrafluoroethylene valved conduit and transcatheter stent graft system was evaluated on Peak pressure gradient and regurgitant fraction. In a mock circulatory system, trileaflet polytetrafluoroethylene valved conduits demonstrated peak pressure gradients of 4.7-13.2 mmHg and regurgitant fractions of 1.6-4.9% across various sizes.
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