Reproducible Technique For Construction Of PTFE-Valved Conduit
Shelby Aughtman, MD1, Peter Wearden, MD, PhD2, Jennifer Nelson, MD, MS2.
1Eastern Virginia Medical School, Norfolk, VA, USA, 2Nemours Children's Health, Orlando, FL, USA.
Objective(s): Surgeon-fashioned PTFE valved conduits have gained popularity in congenital heart surgery as a viable alternative to homograft and other conduit materials, and outcomes in older children are promising. Methods for educating surgeons to reproducibly construct these conduits, as well as early outcomes in infants and young children during this learning curve, are not well-described. We present the surgeon education process for children who received surgeon-fashioned PTFE valved right ventricle to pulmonary artery conduits during initial method implementation.
Methods: Congenital surgeon education included four classroom hours of proctored instruction/supervised valve construction followed by two hours of individual practice. A surgeon with prior mastery of the technique provided templated designs, video demonstrating proper valved conduit construction, and availability for virtual follow-up consultation. After education and independent construction of four conduits of varying sizes, the surgeon-learners constructed conduits for patient use.
Results: Two congenital cardiac surgeons were educated using the method described. Nine patients subsequently underwent right ventricle to pulmonary artery conduit implantation utilizing surgeon-fashioned PTFE valved conduits. As of 15 months of follow-up, there have been no major complications or mortality.
Conclusions: Six hours of proctored surgeon education and deliberate practice are effective for teaching a reproducible technique of valved PTFE conduit construction for patient use. Outcomes during our program's initial experience were favorable, with no patient having greater than mild conduit valve stenosis or regurgitation at discharge. This video demonstration provides educational methods for congenital cardiac surgeons wishing to learn and adopt this technique.
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