Medium-term outcomes of bovine jugular vein graft and homograft conduits in children.

Background The bovine jugular vein ( Contegra) conduit has been described as an alternative to the homograft for right ventricle ( RV) to pulmonary artery ( PA) connection. We assessed the outcomes of Contegra conduits and homografts at a single institution. Methods We conducted a retrospective review of children ( n = 249) who underwent RV-to- PA conduit ( Contegra 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 Ross procedure ( n = 61; 25%). There were 113 (45%) Contegra 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 Contegra 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 New York Heart Association Class II/ I. Conclusion The Contegra conduit and homograft demonstrate similar mid-term outcomes in children. Smaller conduit size is associated with higher graft failure and mortality. [ABSTRACT FROM AUTHOR]