Comparative Analysis of Early Outcomes In Polytetrafluoroethylene (Ptfe) Patch Versus Bovine Pericardial Patch for Monocusp For Right Ventricular Outflow Tract Reconstruction of Tetralogy of Fallot (Tof) Repair

Authors

  • Muhammad Majid Department of Paediatric Cardiac Surgery, Armed Forces Institute of Cardiology/National Institute of Heart Diseases/National University of Medical Sciences (NUMS) Pakistan
  • Dawood Kamal Mehsood Department of Paediatric Cardiac Surgery, Armed Forces Institute of Cardiology/National Institute of Heart Diseases/National University of Medical Sciences (NUMS) Pakistan
  • Intisar ul Haq Department of Paediatric Cardiac Surgery, Armed Forces Institute of Cardiology/National Institute of Heart Diseases/National University of Medical Sciences (NUMS) Pakistan
  • Nasir Ali Khan Department of Cardiac Surgery, Armed Forces Institute of Cardiology/National Institute of Heart Diseases/National University of Medical Sciences (NUMS) Pakistan
  • Muhammad Abdullah Department of Paediatric Cardiac Anesthesia, Armed Forces Institute of Cardiology/National Institute of Heart Diseases/National University of Medical Sciences (NUMS) Pakistan
  • Muhammad Adnan Akram Department of Paediatric Cardiac Anesthesia, Armed Forces Institute of Cardiology/National Institute of Heart Diseases/National University of Medical Sciences (NUMS) Pakistan

DOI:

https://doi.org/10.51253/pafmj.v76iSUPPL-3.13578

Keywords:

Pericardium, Polytetrafluoroethylene, Pulmonary Regurgitation, Tetralogy of Fallot, Treatment Outcome

Abstract

Objective: To compare early outcomes of polytetrafluoroethylene patch (PTFE) versus bovine pericardial patch for monocusp in right ventricular outflow tract reconstruction of Tetralogy of Fallot (TOF) repair.

Study design:  Quasi-experimental study.

Place and Duration of Study: Department of Paediatric and Congenital Cardiac Surgery, Armed Forces Institute of Cardiology and National Institute of Heart Diseases (AFIC-NIHD), Rawalpindi, Pakistan, from Jun 2024 to May 2025.

Methodology: A total of 32 children aged ≤15 years, with transannular TOF were recruited through non-probability consecutive sampling and non-randomly allocated into groups based on the TOF repair technique: Group PTFE or Group bovine pericardial patch. All operative procedures were performed with median sternotomy under cardiopulmonary bypass (CPB) with moderate hypothermia. Early outcomes were compared between groups including peri-operative pulmonary regurgitation and residual right ventricular outflow tract pressure gradient (RVOT-PG), CPB time, aortic cross-clamp (ACC) time, ventilation time, Intensive Care Unit (ICU) stay and mortality.

Results: Out of 32 patients, 19(58.80%) were male and 13(41.20%) were female while median age was 2.25 (6.50-1.58) years. Moderate pulmonary regurgitation (PR) was observed in 11.80% of the cases in PTFE group as compared to 29.40% of cases in Bovine group, however, this difference was not statistically significant (p>0.05) where RVOT-PG was significantly higher in the PTFE group (32.94±8.47 vs. 24.12±11.72 mmHg, p=0.01) on peri-operative echocardiogram.

Conclusion: Similar early results were seen with RVOT reconstruction using PTFE and bovine pericardial monocusps, although it was statistically not significant, PTFE provided better protection against moderate pulmonary regurgitation.

Downloads

Download data is not yet available.

References

1. Rago M, Winlaw DS, Farajikhah S, Dehghani F, Naficy S. Pediatric pulmonary valve replacements: clinical challenges and emerging technologies. Bioeng Transl Med 2023; 8: e10501. https://doi.org/10.1002/btm2.10501

2. Romeo JLR, Etnel JRG, Takkenberg JJM, Roos‑Hesselink JW, Helbing WA, van de Woestijne P, et al. Outcome after surgical repair of tetralogy of Fallot: a systematic review and meta‑analysis. J Thorac Cardiovasc Surg 2020; 159: 220–236.e8. https://doi.org/10.1016/j.jtcvs.2019.08.127

3. Mehsood DK, Ahmad K, Ul‑Haq I, Umair Younus R, Imran M, Majid M. Comparative analysis in early outcomes of different surgical repair techniques in adult patients with unrepaired tetralogy of Fallot – 10 years experience. Pak Armed Forces Med J 2024; 74(Suppl‑1): S68–S73. https://doi.org/10.51253/pafmj.v74iSUPPL‑1.11763

4. Zhang L, Liu B, Li H, Wang C, Yang S, Li Z. Epidemiology of congenital heart disease in Jinan, China from 2005 to 2020: a time trend analysis. Front Cardiovasc Med 2022; 9: 815137. https://doi.org/10.3389/fcvm.2022.815137

5. Bhushan R, Chugh V, Loona M, Bandey J, Jhajhria NS, Grover V, et al. Intracardiac repair in late adolescent and adult tetralogy of Fallot – early and midterm results from a tertiary care centre. Braz J Cardiovasc Surg 2022; 37: 511–516. https://doi.org/10.21470/1678-9741-2020-0528

6. Siddiqi U, Adewale A, Pena E, Schulz K, Ilbawi M, El‑Zein C, et al. Preserving the pulmonary valve in tetralogy of Fallot repair: reconsidering the indication for valve‑sparing. J Card Surg 2022; 37: 5144–5152. https://doi.org/10.1111/jocs.17156

7. Waqar T, Ansari MZA, Khan K. Clinical outcome of right ventricle outflow tract management for repair of tetralogy of Fallot with three contemporary surgical strategies. Pak J Med Sci 2021; 37: 1313–1318. https://doi.org/10.12669/pjms.37.5.3961

8. Wei X, Li T, Ling Y, Chai Z, Cao Z, Chen K, et al. Transannular patch repair of tetralogy of Fallot with or without monocusp valve reconstruction: a meta‑analysis. BMC Surg 2022; 22: 18. https://doi.org/10.1186/s12893-022-01474-6

9. Temur B, Aydin S, Suzan D, Kirat B, Demir IH, Erek E. Comparison of different pulmonary valve reconstruction techniques during transannular repair of tetralogy of Fallot. J Card Surg 2021; 36: 56–61. https://doi.org/10.1111/jocs.15133

10. Amirghofran A, Edraki F, Edraki M, Ajami G, Amoozgar H, Mohammadi H, et al. Surgical repair of tetralogy of Fallot using autologous right atrial appendages: short‑ to mid‑term results. Eur J Cardiothorac Surg 2021; 59: 697–704. https://doi.org/10.1093/ejcts/ezaa374

11. Shi WE, Song FX, Li X, Jun LS, Hao Z. Surgical outcome after complete repair of tetralogy of Fallot with absent pulmonary valve: comparison between bovine jugular vein valved conduit and monocusp valve patch. World J Pediatr 2018; 14: 510–519. https://doi.org/10.1007/s12519-018-0169-z

12. Patukale A, Daley M, Betts K, Justo R, Dhannapuneni R, Venugopal P, et al. Outcomes of pulmonary valve leaflet augmentation for transannular repair of tetralogy of Fallot. J Thorac Cardiovasc Surg 2021; 162: 1313–1320. https://doi.org/10.1016/j.jtcvs.2020.12.145

13. Rokonujjaman M, Islam SS, Ghafoor N, Siraj N, Ahmad ST, Rahman MA, et al. Surgical repair of TOF: outcome of right ventricular outflow tract reconstruction using modified monocusp at pulmonary valve level – a single cardiac hospital experience in Bangladesh. Anwer Khan Mod Med Coll J 2021; 12: 82–90. https://doi.org/10.3329/akmmcj.v12i2.64698

14. Kumar M, Turrentine MW, Rodefeld MD, Bell T, Brown JW. Right ventricular outflow tract reconstruction with a polytetrafluoroethylene monocusp valve: a 20‑year experience. Semin Thorac Cardiovasc Surg 2016; 28: 463–470. https://doi.org/10.1053/j.semtcvs.2016.05.003

15. Rasool F, Khan A, Shah S, Rahim SS, Kibria G, Kazmi T. RVOT reconstruction strategies in TOF: single center experience. J Popul Ther Clin Pharmacol 2024; 31: 64–70. https://doi.org/10.53555/vqtmwr03

16. Choi SJ, Kwon JE, Roh DE, Hyun MC, Jung H, Lee YO, et al. Importance of pulmonary valve morphology for pulmonary valve preservation in tetralogy of Fallot surgery: comparison of echocardiographic parameters. Clin Exp Pediatr 2020; 63: 189–194. https://doi.org/10.3345/kjp.2019.01060

17. Benedict R, Nalluri R, Vemala V. Novel technique of monocuspid reconstruction of pulmonary valve in children requiring transannular patch for right ventricular outflow tract relief during tetralogy of Fallot surgery. Indian J Thorac Cardiovasc Surg 2025; 41: 83–88. https://doi.org/10.1007/s12055-023-01575-5

18. Daniel S, Gupta P, Bansal K, Nigam A, Agarwal S, Geelani MA. Monocusp pulmonary valve reconstruction in Tetralogy of Fallot: early results and evaluation using 2D echocardiography and 3‑T cardiac MRI. Indian J Thorac Cardiovasc Surg 2025. https://doi.org/10.1007/s12055-024-01652-4

Downloads

Published

30-04-2026

Issue

Section

Original Articles

Categories

How to Cite

1.
Majid M, Kamal Mehsood D, ul Haq I, Ali Khan N, Abdullah M, Akram MA. Comparative Analysis of Early Outcomes In Polytetrafluoroethylene (Ptfe) Patch Versus Bovine Pericardial Patch for Monocusp For Right Ventricular Outflow Tract Reconstruction of Tetralogy of Fallot (Tof) Repair. Pak Armed Forces Med J [Internet]. 2026 Apr. 30 [cited 2026 May 22];76(SUPPL-3):S602-S606. Available from: https://www.pafmj.org/PAFMJ/article/view/13578