In vitro evaluation of hemodynamic performance for right ventricular outflow tract reconstruction with trileaflet ePTFE valved conduit

Right ventricle to pulmonary artery (RV-PA) continuity reconstruction traditionally is treaded by open repair with pulmonary valve implantation or replacement. Percutaneous pulmonary valve implantation (PPVI) has evolved as most exciting development surgical strategy with dysfunctional right ventricle-pulmonary artery conduits. However, size restrictions of the currently available valves for PPVI application prevents development in a larger pool of patients. We propose a formula for designing handmade trileaflet-valved conduits with different diameters. The formula is derived from a trigonometric function and can be used to estimate the optimal parameters for ePTFE-valved conduits for young adults and children. The purpose of this study is to investigate the hemodynamic and functional consequences of the new design using a mock circulation system. We recorded the diastolic valve leakage and calculated pulmonary regurgitation, regurgitation fraction, and ejection efficiency in pulsatile setting. Additionally, the prosthetic leaflet behavior was assessed with an endoscope camera and the pressure drops through valves were measured. All the in vitro parameters indicated that the ePTFE-valved conduits did not have an inferior outcome compared with commercial mechanical or tissue valve conduits and could decrease the regurgitation volume and increase the efficiency. Compatible early clinical outcomes were also found among ePTFE-valved conduits and other valved conduits used for RVOT reconstruction, and ePTFE-valved conduits could be implanted in patients of a significantly smaller size. In vitro experimental study provided evidence that a handmade ePTFE-valved conduit could be an attractive alternative to other commercialized valved conduits used for surgical Right ventricle to pulmonary artery (RV-PA) continuity reconstruction.