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An expanded polytetrafluoroethylene-autologous aortic hybrid valve for right ventricular outflow tract reconstruction in the Ross procedure

^a Department of Pediatric Cardiovascular Surgery, Children's Research Hospital, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi, Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
^b Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi, Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan

*Corresponding author. Tel.: +81-75-251-5752; fax: +81-75-257-5910.

E-mail address: myama{at}koto.kpu-m.ac.jp (M. Yamagishi).

Although the Ross procedure is a well-established approach to aortic valve disease in pediatric patients and young adults, there still is no ideal method of right ventricular outflow tract (RVOT) reconstruction, especially in children. To achieve improved RVOT reconstruction with long-term valve function and growth potential, we have developed a hybrid valve which combines the autologous aortic valve and expanded polytetrafluoroethylene (ePTFE) valves. The posterior wall of RVOT was reconstructed using the autologous aortic wall with a noncoronary cusp, and the anterior wall was reconstructed using a patch made of bovine pericardium or ePTFE with bicuspid ePTFE valves. We implanted hybrid valves in 14 patients (age 5–18 years). During the follow-up period (2.4–8.8 years), there were no mortalities or morbidities, and no patients required reoperation. Echocardiography showed no significant stenosis and regurgitation, and preserved valve motion in all patients. The z-value of the diameters of the pulmonary annulus in early and late follow-up was –1.4 and –1.8, respectively, the difference not being significant. Creation of a hybrid valve was associated with excellent mid- to long-term results. Given its theoretical growth potential, we speculate that this valve could be a good choice for RVOT reconstruction in the Ross procedure, especially for young children.

Key Words: Congenital heart disease; Ross procedure; Right ventricular outflow tract reconstruction; Expanded polytetrafluoroethylene valve; Autologous aortic valve