Polytetrafluoroethylene patch versus autologous pericardial patch for right ventricular outflow tract reconstruction

Abstract

Objective: Reconstruction of right ventricular outflow tract (RVOT) during repair of Tetralogy of Fallot (TOF) often requires placement of a transannular patch (TAP). The purpose of the present study was to compare the outcomes following reconstruction of RVOT using polytetrafluoroethylene (PTFE) patch versus autologous glutaraldehyde-fixed pericardial patch. Materials and Methods: Fifty-three consecutive patients undergoing TAP repair for TOF in a single institute were randomized into two groups: Group I (pericardial patch), Group II (PTFE patch) and their postoperative outcomes in terms of postoperative rhythm, duration of mechanical ventilation, mediastinal and pleural drainage, stay in the Intensive Care Unit (ICU) and hospital, were assessed. The preoperative and postoperative gradients across the RVOT, pulmonary insufficiency, systolic right ventricular function were assessed echocardiographically by an independent cardiology team. Results: There was one death; there were no differences between the two groups regarding the postoperative duration of mechanical ventilation, ICU, and hospital stay. The requirement of inotropes was less in the PTFE patch group compared to the pericardial patch group (12.80 ± 8.04 vs. 17.30 ± 7.21, median 10 vs. 20, P = 0.025). The re-exploration rate in the PTFE group was higher than the other group (6 vs. 1). There was no difference in the RV systolic function between the two groups as assessed by echocardiogram before discharge. Conclusion: RVOT reconstruction during TOF repair can safely be performed using a PTFE patch with results similar to an autologous patch of glutaraldehyde-treated pericardium. Its results in the mid and long term need further evaluation.