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Medium‐term outcomes of bovine jugular vein graft and homograft conduits in children
Author(s) -
Yong Matthew S.,
Yim Deane,
d'Udekem Yves,
Brizard Christian P.,
Robertson Terry,
Galati John C.,
Konstantinov Igor E.
Publication year - 2015
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/ans.13018
Subject(s) - medicine , electrical conduit , surgery , endocarditis , stenosis , jugular vein , ventricle , confidence interval , vein , pulmonary artery , cardiology , mechanical engineering , engineering
Background The bovine jugular vein ( C ontegra) conduit has been described as an alternative to the homograft for right ventricle ( RV ) to pulmonary artery ( PA ) connection. We assessed the outcomes of C ontegra conduits and homografts at a single institution. Methods We conducted a retrospective review of children ( n = 249) who underwent RV ‐to‐ PA conduit ( C ontegra or homograft) implantation from 2001 to 2011. Results Median operation age was 4.8 years (2 days–18 years). Indications for surgery were as follows: primary conduit insertion ( n = 131; 53%), previous conduit failure ( n = 57; 23%) or R oss procedure ( n = 61; 25%). There were 113 (45%) C ontegra conduits and 136 (55%) homografts (92 pulmonary, 44 aortic) inserted. Early mortality was 5% ( n = 12). Overall survival was 89% (95% confidence interval ( CI ): 84–92%) at 5 years and 87% (95% CI : 81–92%) at 10 years. Mortality was associated with smaller conduit size ( P = 0.044) and syndrome diagnosis ( P = 0.012). Freedom from reoperation was 85% (95% CI : 77–91%) and 75% (95% CI : 59–86%) at 5 years for homografts and C ontegra conduits, respectively. Patients required conduit replacement (15%) for endocarditis ( n = 4; 11%) or graft failure ( n = 34; 89%). Eleven patients developed distal conduit stenosis with the majority occurring in Contegra conduits ( n = 7; 64%) ( P = 0.004). A larger conduit ( P = 0.007) was protective against reoperation. There was no difference in reoperation between conduits ( P = 0.41). Mean follow‐up was 5 ± 3.2 years (96% complete). Majority of survivors (99%) were in N ew Y ork H eart A ssociation Class II / I . Conclusion The C ontegra conduit and homograft demonstrate similar mid‐term outcomes in children. Smaller conduit size is associated with higher graft failure and mortality.