In vitro construction of handmade polytetrafluoroethylene right ventricle-to-pulmonary artery valved conduit using a modification of the Ozaki technique

Objective: To develop a polytetrafluoroethylene (PTFE) valved conduit for right ventricle-to-pulmonary artery (RV-PA) reconstruction using a modified technique of the aortic neocuspidization described by Ozaki. Methods: Between June 2024 and September 2025, 12 patients underwent the placement of handmade PTFE valved RV-PA conduits. An inverted PTFE graft was marked for commissures and cusp nadirs. Three leaflets were fashioned from 0.1-mm PTFE membrane using Ozaki's sizer and template. Leaflets were sutured to the inner wall following the technique of Ozaki. Graft was then re-everted and commissures secured, ensuring symmetrical leaflet coaptation. Results: Median patient age was 12 years (interquartile range [IQR], 7, 15 years); male/female ratio was 7:5; median weight 25 kg (IQR, 17, 30 kg); and median body surface area was 0.9 (IQR, 0.7, 1.2). Diagnoses included double-outlet right ventricle ventricular septal defect pulmonary stenosis (n = 5), tetralogy of Fallot (TOF) (n = 2), post-Ross procedure (n = 2), TOF with subarterial ventricular septal defect (n = 1), atrioventricular canal defect with TOF (n = 1), and TOF postconduit (n = 1). Median peak preoperative right ventricular outflow tract gradient was 83 mm Hg (IQR, 77, 92 mm Hg). Median bypass time and clamp time were 173 minutes (IQR, 147, 218 minutes) and 137 minutes (IQR, 93, 162 minutes), respectively. Median conduit size was 19 mm (IQR, 16, 20 mm) versus expected PA annulus of 15 mm (IQR, 13.7, 16 mm). Median peak conduit gradient was 10 mm Hg (IQR, 3,16) immediately (n = 12), 10 mm Hg (IQR 3,17) at 1 month (n = 12), 10 mm Hg (IQR 3,18) at 3 months (n = 11), 12 mm Hg (IQR 5,18) at 6 months (n = 9), and 12 mm Hg (IQR 3,20) at 1 year (n = 7). Trivial, nonprogressive regurgitation was noted in 2 patients. Conclusions: This conduit is a simple, economical, and reproducible option for RV-PA reconstruction. It provides favorable early hemodynamic performance, demonstrating promise as a durable and accessible alternative to commercially available conduits.