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19189 ODonnell REVISED.m4v (1.25 GB)

Technique For Trileaflet Expanded Polytetrafluoroethylene Valved Conduit Creation

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posted on 2023-12-12, 16:34 authored by Alan O'Donnell, David Morales, David Winlaw, David Lehenbauer, Awais Ashfaq

The technique in this video demonstrates how to implant a leaflet apparatus into any conduit type. This includes conduits not previously demonstrated, such as ring-reinforced ePTFE and sinus of Valsalva conduits. Utilizing this technique, the cost of one conduit is $828 – $1,033 compared to commercially available conduits, which cost $4,995 – $12,500.

Advantages of handmade conduits with bileaflet and trileaflet ePTFE valves are well documented in right ventricular outflow tract (RVOT) reconstruction. With comparable results to commercially available conduits, ePTFE conduits are also more available, durable, and significantly cheaper. This video presents a technique to construct trileaflet ePTFE conduits that will offer unparalleled customizability in RVOT reconstruction. Based on design from the Ando/Takahashi group experience, several modifications were made to allow for creation of bespoke conduits in sizes from 5 mm – 38 mm in any conduit type.

Patients undergoing a Norwood Procedure with high PVR, such as an intact atrial septum, or those with systemic atrioventricular valve or neo-aortic valve regurgitation could potentially benefit from a trileaflet valve in a 5 or 6 mm ring-reinforced ePTFE conduit. Biologic valved conduits have been used in this position (cryopreserved vein graft, homograft/ePTFE composites, etc.) with reasonable success in the immediate postoperative period. However, nearly all required conduit reintervention in the interstage period. The technique in this video describes a more durable solution that could last the entire interstage period.

The authors have implanted eighteen conduits in sizes 10 mm – 32 mm in patients from 3.8 – 114.3 kg since 2020. One conduit used in a salvage ECMO case was stented early. All others have no more than mild stenosis, with max 18 mmHg in one patient, and trivial regurgitation via TTE.

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