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Systematic Analysis of PTFE Monocusp Leaflet Design in a Patient-Based 3D in-Vitro Model of Tetralogy of Fallot. | LitMetric

AI Article Synopsis

  • The study aimed to evaluate how different design parameters of pulmonary valve monocusps impact valve function in a 3D-printed model of the right ventricular outflow tract for Tetralogy of Fallot repairs.
  • Tests were conducted under physiological conditions for infants, where factors like leaflet free edge lengths, positions, and scallop depths were varied, focusing primarily on pressure gradients and regurgitation.
  • Optimal leaflet designs were identified as those with widths of 140-160% in a 40% backwall model and 110-120% in a 50% backwall model, positioned slightly beyond the anatomical junction, showing the best balance between gradient and regurgitation for future evaluations.

Article Abstract

Purpose: Pulmonary valve (PV) monocusp reconstruction in transannular patch (TAP) right ventricular outflow tract (RVOT) repair for Tetralogy of Fallot has variable clinical outcomes across different surgical approaches. The study purpose was to systematically evaluate how monocusp leaflet design parameters affect valve function in-vitro.

Methods: A 3D-printed, disease-specific RVOT model was tested under three infant physiological conditions. Monocusps were sewn into models with the native main pulmonary artery (MPA) forming backwalls that constituted 40% and 50% of the reconstructed circumference for z-score zero PV annulus and MPA diameters (native PV z-score - 3.52 and - 2.99 for BSA 0.32m). Various leaflet free edge lengths (FEL) (relative to backwall), positions (relative to PV STJ), and scallop depths were investigated across both models. Pressure gradient, regurgitation, and coaptation were analyzed with descriptive statistics and regression models.

Results: Increasing FEL beyond 100% of the MPA backwall decreased gradient but mildly increased regurgitation to a peak of 25%. Positioning the free edge 2 mm past the STJ mildly increased gradient for each FEL without significantly changing regurgitation compared to STJ placement. Scalloping leaflets trivially affected performance. Pre-folding leaflets improved mobility and slightly reduced gradient.

Conclusions: Balancing gradient, regurgitation, and oversizing for growth, a set of leaflet designs have been selected for pre-clinical evaluation. Designs with leaflet widths 140-160% in the 40% backwall model (110-120% in the 50% backwall), positioned at or 2 mm past the STJ, demonstrated the best results. The next stage of ex-vivo testing will additionally consider native RVOT distensibility, native leaflet interactions, and TAP characteristics.

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Source
http://dx.doi.org/10.1007/s13239-023-00690-2DOI Listing

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