Right ventricular outflow tract reconstruction with the Contegra bovine jugular vein conduit: a word of caution.
BACKGROUND
Since introduction in 1999, pulmonary valve replacement in pediatric patients with the Contegra conduit (Medtronic Inc, Minneapolis, MN) has gained widespread application with increasing enthusiasm. However, unexpected graft related adverse effects may occur.


METHODS
Between April 2001 and December 2002, 29 patients (20 male; mean age, 3.39 +/- 3.66 years; range, 0.01 to 13.0 years; mean weight, 11.62 +/- 8.73 kg) underwent right ventricular outflow tract reconstruction with the Contegra conduit. Seventeen patients underwent primary repair, 8 had prior homografts, and 4 had other previous operations.


RESULTS
There were no deaths. Three early graft related complications were observed. In two infants (age, 1.8 and 3.5 months; weight, 3.6 and 3.8 kg, respectively) thrombus formation at the conduit valve was detected 2 weeks postoperatively. Under anticoagulation with low-molecular-weight heparin, thrombi resolved completely in both patients. One patient (4.5 months, 4.43 kg) developed severe regurgitation due to a fibrous layer covering the inner conduit wall and required conduit exchange 3 weeks postoperatively. After a mean follow-up time of 10.2 +/- 6.4 months all patients are in good clinical condition. However, one patient with systemic right ventricular pressure developed pseudoaneurysm at both graft insertion sites and is scheduled for reoperation. Two other patients underwent balloon dilation. Freedom from reoperation and intervention at 1 year is 89.4%. With regard to regurgitation and conduit stenosis all other conduits perform well.


CONCLUSIONS
Contegra conduits are an alternative to homografts for right ventricular outflow tract reconstruction. However, there is a risk of thrombus formation in small infants so that prophylactic anticoagulation may be necessary. Patients with systemic right ventricular pressure require close observation as pseudoaneurysm formation has been observed.
Tiete
Andreas R
AR
Department of Cardiac Surgery, University Hospital Grobetahadern, Munich, Germany. atiete@med.uni-muenchen.de
Sachweh
Jörg S
JS
Roemer
Ulrich
U
Kozlik-Feldmann
Rainer
R
Reichart
Bruno
B
Daebritz
Sabine H
SH
D000293:Adolescent; D001705:Bioprosthesis / Q000009:adverse effects; D001807:Blood Vessel Prosthesis / Q000009:adverse effects; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery; D006350:Heart Valve Prosthesis; D006352:Heart Ventricles / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D011183:Postoperative Complications; D011651:Pulmonary Artery / Q000601:surgery*; D013927:Thrombosis / Q000209:etiology