Handmade tri-leaflet ePTFE conduits versus homografts for right ventricular outflow tract reconstruction

Background This study aimed to investigate the performance of handmade tri-leaflet expanded polytetrafluoroethylene(ePTFE)conduits in the absence of a suitable homograft.Methods Patients who underwent right ventricular outflow tract reconstruction with tri-leaflet ePTFE conduits or homografts between December 2016 and August 2020 were included.The primary endpoint was the incidence of moderate or severe conduit stenosis(>36 mmHg)and/or moderate or severe insufficiency.The secondary endpoint was the incidence of severe conduit stenosis(>64 mmHg)and/or severe insufficiency.Results There were 102 patients in the ePTFE group and 52 patients in the homograft group.The median age was younger[34.5(interquartile range:20.8-62.8)vs.60.0(interquartile range:39.3-81.0)months,P=0.001]and the median weight was lower[13.5(10.0-19.0)vs.17.8(13.6-25.8)kg,P=0.003]in the ePTFE group.The conduit size was smaller(17.9±2.2 vs.20.5±3.0 mm,P<0.001)and the conduit Z score was lower(1.48±1.04 vs.1.83±1.05,P—0.048)in the ePTFE group.There was no significant difference in the primary endpoints(log rank,T3=0.33)and secondary endpoints(log rank,P=0.35).Multivariate analysis identified lower weight at surgery[P=0.01;hazard ratio:0.75;95%confidence interval(CI)0.59-0.94]and homograft conduit use(P=0.04;hazard ratio:8.43;95%CI 1.14—62.29)to be risk factors for moderate or severe conduit insufficiency.No risk factors were found for moderate or severe conduit stenosis or conduit dysfunction on multivariate analysis.Conclusion Handmade tri-leaflet ePTFE conduits showed acceptable early and midterm outcomes in the absence of a suitable homograft,but a longer follow-up is needed.