Mid term course after pediatric right ventricular outflow tract reconstruction: a comparison of homografts, porcine xenografts and Contegras.
OBJECTIVE
Homografts and porcine xenografts are valved conduits for pediatric RVOT reconstruction. They lack availability and durability. The Contegra, a glutaraldehyde fixed bovine jugular vein, was developed as an alternative. In this article, we compare single center results of 190 RVOT conduit implantations.


METHODS
52 homografts, 30 porcine xenografts, 108 Contegras were implanted since 1992. Since 1999, data collection was prospective, for Contegras within a controlled clinical trial. Follow-up is complete for all evaluated items. We stratified reoperations by problem zone (sub-, intra-, and supravalvular) and analyzed the role of patient age, diagnosis, graft type, graft size, previous operations and year of operation on freedom from explantation or reoperation related to supravalvular reasons.


RESULTS
Porcine xenografts were inferior concerning freedom from explantation and reoperation (P<0.0001). They gave erlier reason for explantation in each zone (P<0.001). At 4 years, homograft valve related reoperation need reached 20%, Contegras 0% (P=0.002). Supravalvlar reoperation reasons developed about equally in homografts and Contegras. Multivariable Cox' regression analysis showed porcine xenografts and age <1 year as independent risk factors for explantation due to supravalvular reasons. We found no reason to assume that supravalvular reoperation reasons occured more frequently after Contegra than after homograft implantation.


CONCLUSIONS
After 12 years RVOT reconstruction with 190 valved conduits, Contegras remain our device of choice. At 4 years, they show no subvalvular or valvular reason for explantation or reoperation. Contegras have the advantages of easy handling and availability, and they compare well with homografts regarding freedom from explantation and freedom from reoperation.
Boethig
Dietmar
D
Department for Pediatric Cardiology and Intensive Care, Hannover Medical School, Carl-Neuberg-Str. 1, D-30625 Hannover, Germany.
Thies
Wolf-Rüdiger
WR
Hecker
Hartmut
H
Breymann
Thomas
T
D000293:Adolescent; D000328:Adult; D000818:Animals; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D006348:Cardiac Surgical Procedures / Q000379:methods; D002417:Cattle; D002648:Child; D002675:Child, Preschool; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007601:Jugular Veins / Q000637:transplantation; D008297:Male; D011475:Prosthesis Failure; D012086:Reoperation; D013552:Swine; D014183:Transplantation, Heterologous; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D018497:Ventricular Dysfunction, Right / Q000601:surgery*