title: The Contegra conduit in the right ventricular outflow tract induces supravalvular stenosis.
abstract: OBJECTIVE
  We sought to evaluate the incidence and nature of pulmonary stenosis after implantation of the bovine jugular vein graft (Contegra; Medtronic, Inc, Minneapolis, Minn) in the right ventricular outflow tract.
  
  
  METHODS
  Between May 2000 and September 2002, 58 Contegra conduits (8-22 mm) were implanted during primary (n = 27) or redo operations (n = 31) in 57 patients, with ages ranging from 2 days to 48 years (mean, 9 years). Indications were truncus arteriosus (n = 16), tetralogy of Fallot (n = 28), pulmonary replacement in the Ross operation (n = 10), and Rastelli-type repair for double-outlet right ventricle (n = 4). Echocardiography was prospectively performed by a fixed team of investigators during follow-up (mean, 22.7 +/- 10 months). A peak gradient of greater than 50 mm Hg was considered severe stenosis.
  
  
  RESULTS
  Two patients died from Staphylococcus aureus -induced septicemia and enterococcal endocarditis after 12 days and 12 weeks, respectively. One patient died of heart failure caused by endocardial fibroelastosis after 1 year. Freedom from severe stenosis at the distal anastomosis was 91% +/- 3% at 3 months, 68% +/- 6% at 12 months, and 49% +/- 8% at 24 months. The risk of development of stenosis does not change over time. Younger age and its derivatives (graft size and indication) are significantly related to the occurrence of severe stenosis ( P < .0001). Seventeen (29%) conduits required an endovascular intervention (balloon dilatation or stent). Seven (12%) conduits were explanted (endocarditis, 2; stenosis, 5). Histologic analysis of the explanted conduits showed excessive proliferation of neointima at the level of the distal anastomosis. Valve regurgitation was observed in 9 (16%) conduits and was always secondary to dilatation in the presence of severe distal stenosis.
  
  
  CONCLUSIONS
  The Contegra conduit induces a neointimal proliferation at the level of the pulmonary anastomosis. This leads to a high incidence of severe stenosis at intermediate-term follow-up.
authors.affiliation: Department of Cardiac Surgery, University Hospital Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium. Bart.Meyns@uz.kuleuven.ac.be
authors.forename: Bart
authors.initials: B
authors.lastname: Meyns
authors.forename: Leen
authors.initials: L
authors.lastname: Van Garsse
authors.forename: Derize
authors.initials: D
authors.lastname: Boshoff
authors.forename: Benedicte
authors.initials: B
authors.lastname: Eyskens
authors.forename: Luc
authors.initials: L
authors.lastname: Mertens
authors.forename: Marc
authors.initials: M
authors.lastname: Gewillig
authors.forename: Steffen
authors.initials: S
authors.lastname: Fieuws
authors.forename: Erik
authors.initials: E
authors.lastname: Verbeken
authors.forename: Willem
authors.initials: W
authors.lastname: Daenen
mesh_terms: D000293:Adolescent; D000328:Adult; D000818:Animals; D021921:Aortic Stenosis, Supravalvular / Q000209:etiology*; D001807:Blood Vessel Prosthesis / Q000009:adverse effects; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D002417:Cattle; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007601:Jugular Veins / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D011664:Pulmonary Valve / Q000473:pathology; D013771:Tetralogy of Fallot / Q000601:surgery; D014338:Truncus Arteriosus / Q000601:surgery; D017539:Tunica Intima / Q000473:pathology