Outcomes of Handmade Tri-leaflet ePTFE Valved Conduits for RVOT Reconstruction: A Propensity-Matched Analysis Compared with PVR

Q: What are the key findings of this study?

Large-caliber handmade ePTFE valved conduits achieved 94% 10-year freedom from RVOT reoperation compared to 89% with bioprosthetic PVR in propensity-matched patients (p=0.34).

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Congenital heart disease requiring right ventricular outflow tract (RVOT) reconstruction (n=100). Intervention: Handmade tri-leaflet ePTFE valved conduit vs. Bioprosthetic pulmonary valve replacement (PVR). Primary outcome: 10-year freedom from RVOT reoperation (propensity-matched cohort) (p=0.34).

Q: What does this research mean for the field?

Large-caliber handmade ePTFE valved conduits provide long-term durability and freedom from RVOT reoperation comparable to bioprosthetic pulmonary valve replacement in adolescent- and adult-sized patients. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

直樹 正木; Junichi Koizumi; Yuya Yamazaki; Daichi Edaki; Kanchi Saito; Akira Sato; Yurie Takizawa; Satoshi Nakano; Hirofumi Saiki; Akio Ikai; Hajime Kin

doi:10.1007/s00246-026-04533-4

October 27, 2026Pediatric CardiologyOpen Access

Outcomes of Handmade Tri-leaflet ePTFE Valved Conduits for RVOT Reconstruction: A Propensity-Matched Analysis Compared with PVR

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Key result

Handmade ePTFE valved conduits show no significant difference in 10-year RVOT reoperation versus bioprosthetic PVR.

P=0.34
n=100

Why the study?

The comparative outcomes and role of handmade ePTFE valved conduits versus bioprosthetic pulmonary valve replacement for RVOT reconstruction in pediatric and adolescent patients required evaluation.

Does RVOT reconstruction using handmade tri-leaflet ePTFE valved conduits provide comparable freedom from reoperation and long-term valve durability compared to bioprosthetic pulmonary valve replacement in patients with congenital heart disease?

Key Points

To evaluate long-term outcomes of right ventricular outflow tract (RVOT) reconstruction using handmade expanded polytetrafluoroethylene (ePTFE) valved conduits compared with bioprosthetic pulmonary valve replacement (PVR).
Retrospective single-center study of N=100 patients undergoing RVOT reconstruction between 2007 and 2025, divided into small-conduit (n=24), large-conduit (n=42), and bioprosthetic PVR (n=34) groups.
Mean follow-up ranged from 6 to 8 years across groups (8.0 ± 4.8 years in small-conduit, 6.4 ± 5.1 in large-conduit, and 7.7 ± 4.8 in PVR; p=0.38).
Propensity score matching yielded 19 well-balanced pairs between the large ePTFE conduit and PVR groups to compare reoperation and valve hemodynamics.
Overall 10-year survival was 100% in the small-conduit group, 100% in the large-conduit group, and 97% in the PVR group (p=0.19).
Ten-year freedom from RVOT reoperation was significantly lower in the small-conduit group (53%) than in the large-conduit (85%) and PVR groups (93%; p<0.001), driven by progressive stenosis (10-year freedom from moderate pulmonary stenosis: 9% vs 55% vs 58%; p=0.01).
In the propensity-matched cohort, 10-year freedom from RVOT reoperation did not differ significantly between ePTFE conduits and PVR (94% vs 89%; p=0.34), with 10-year freedom from moderate stenosis at 55% vs 35% (p=0.26) and regurgitation at 91% vs 79% (p=0.56).

Study Design

Type

Cohort (n=100)

Multicenter

No

Structured PICO

Does RVOT reconstruction using handmade tri-leaflet ePTFE valved conduits provide comparable freedom from reoperation and long-term valve durability compared to bioprosthetic pulmonary valve replacement in patients with congenital heart disease?

P

Population

100 pediatric, adolescent, and young adult patients (54% female) with congenital heart disease undergoing RVOT reconstruction with ePTFE conduits or bioprosthetic valves, followed for a mean of 6 to 8 years.

E

Exposure

Right ventricular outflow tract (RVOT) reconstruction using intraoperatively constructed handmade tri-leaflet expanded polytetrafluoroethylene (ePTFE) valved conduits (n=66: small-conduit ≤ 16 mm, n=24; large-conduit ≥ 18 mm, n=42), with routine postoperative aspirin administration

C

Comparator

Pulmonary valve replacement (PVR) using bioprosthetic valves (n=34, primarily 25- or 27-mm Carpentier–Edwards Perimount Magna and Inspiris valves), with routine postoperative aspirin administration

O

Outcome

Freedom from RVOT reoperation (conduit or valve replacement) at 10 yearshard clinical

Main Result

Absolute Event Rate: 94% vs 89%

p-value: p=0.34

Large-caliber (≥18 mm) handmade tri-leaflet ePTFE valved conduits provide long-term durability and freedom from reoperation comparable to bioprosthetic pulmonary valve replacement in adolescent and adult-sized patients undergoing RVOT reconstruction.

Limitations

Retrospective single-center design with a relatively small sample size
Residual confounding and treatment selection bias despite propensity score matching
Excluded alternative conduit and valve options such as homografts, bovine jugular vein conduits, and mechanical valves
Potential temporal bias due to changes in surgical techniques and management over the 18-year study period
Retrospective single-center study with a relatively small sample size
Residual confounding and treatment selection bias could not be completely eliminated despite propensity score matching
Did not evaluate outcomes of other conduit and valve options, such as homografts, bovine jugular vein conduits, or mechanical valve replacement
Changes in surgical techniques, conduit selection, and patient management over the long study period (2007–2025) may have introduced temporal bias

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Implication

Supports consideration of large-caliber ePTFE conduits for RVOT reconstruction in older children; leaves open prospective trials to confirm equivalence.

Abstract

We retrospectively evaluated outcomes of right ventricular outflow tract (RVOT) reconstruction with handmade expanded polytetrafluoroethylene (ePTFE) valved conduits or pulmonary valve replacement (PVR) bioprosthetic valves, focusing on their role in pediatric and adolescent patients. We included 100 patients undergoing RVOT reconstruction between 2007 and 2025: 66 with ePTFE conduits and 34 with bioprosthetic valves. Patients were categorized into small-conduit, large-conduit, and PVR groups. Propensity score matching was performed to adjust for baseline differences. Mean age was 1.6 ± 1.8, 11.2 ± 6.5, and 26.3 ± 16.9 years in the small-conduit, large-conduit, and PVR groups, respectively (p < 0.0001). Ten-year survival was similar among groups (100%, 100%, and 97%; p = 0.19). In contrast, the small-conduit group showed significantly lower freedom from RVOT reoperation than the large-conduit and PVR groups (53%, 85%, and 93%; p < 0.001), driven by progressive pulmonary stenosis (10-year freedom from moderate pulmonary stenosis: 9%, 55%, and 58%; p = 0.01). Freedom from moderate pulmonary regurgitation remained comparable (80%, 94%, and 85%; p = 0.37). In the matched cohort, conduit and PVR groups demonstrated similar freedom from reoperation (94% vs 89%; p = 0.34), with numerically better valve function in the conduit group. In conclusion, large-caliber handmade ePTFE valved conduits demonstrated favorable long-term durability, with outcomes comparable to PVR in adolescent- and adult-sized patients. They may be a reasonable option for selected younger patients requiring redo RVOT reconstruction.

Discussion

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Cite This Study

正木 et al. (2026) conducted a cohort in Congenital heart disease requiring right ventricular outflow tract (RVOT) reconstruction (n=100). Handmade tri-leaflet ePTFE valved conduit vs. Bioprosthetic pulmonary valve replacement (PVR) was evaluated on 10-year freedom from RVOT reoperation (propensity-matched cohort) (p=0.34). Large-caliber handmade ePTFE valved conduits achieved 94% 10-year freedom from RVOT reoperation compared to 89% with bioprosthetic PVR in propensity-matched patients (p=0.34).

synapsesocial.com/papers/6aee6b6871a75948062208ca https://doi.org/10.1007/s00246-026-04533-4

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Outcomes of Handmade Tri-leaflet ePTFE Valved Conduits for RVOT Reconstruction: A Propensity-Matched Analysis Compared with PVR

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Outcomes of Handmade Tri-leaflet ePTFE Valved Conduits for RVOT Reconstruction: A Propensity-Matched Analysis Compared with PVR

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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