title: Right ventricular outflow tract reconstruction with the bovine jugular vein graft: 5 years' experience with 133 patients.
abstract: BACKGROUND
  We analyzed the results in two centers of using bovine jugular vein graft for right ventricular outflow tract reconstruction.
  
  
  METHODS
  From April 1999 to July 2005, 133 children with a median age of 30.9 months (range, 4 days to 19 years) underwent graft implantation. Echocardiography was performed during follow-up and retrospectively reviewed.
  
  
  RESULTS
  Nongraft-related early mortality occurred in 8 patients. Late mortality occurred in 11 patients, 2 late deaths were graft related (endocarditis). Median follow-up was 31.6 months (range, 1 to 73). Twelve patients received a new graft, because of endocarditis (3), distal pulmonary artery branch stenosis (4), graft obstruction caused by fibrosis (4), or thrombosis (1). Echocardiography Doppler studies showed good conduit function, with 92% of the patients having absent, trivial, or only mild valve regurgitation at last follow-up. A moderate degree of conduit stenosis due to external compression was observed in 2 patients. Twenty-five patients with otherwise intact conduits had hemodynamically significant distal stenosis. In most cases, the pulmonary branch stenosis was related to preoperative small pulmonary arteries and young age at operation. At 31.6 months, significant graft dilatation was observed in 4 grafts and was related to pulmonary artery branch obstruction or pulmonary hypertension. Calcification did not occur in 5 years time. Survival was 85.7%, freedom from conduit explantation was 91%, and freedom from intervention for pulmonary artery branch stenosis was 80% after 5 years.
  
  
  CONCLUSIONS
  The bovine jugular vein graft is a valuable right ventricular outflow tract conduit, but younger age and small pulmonary arteries increase the risk of distal conduit stenosis.
authors.affiliation: Pediatric Cardiology Unit, Department of Cardiac Surgery, Centre Hospitalier Universitaire Vaudoise, Lausanne, Switzerland.
authors.forename: Nicole
authors.initials: N
authors.lastname: Sekarski
authors.forename: Hélène
authors.initials: H
authors.lastname: van Meir
authors.forename: Marry E B
authors.initials: ME
authors.lastname: Rijlaarsdam
authors.forename: Paul H
authors.initials: PH
authors.lastname: Schoof
authors.forename: David R
authors.initials: DR
authors.lastname: Koolbergen
authors.forename: Jaroslav
authors.initials: J
authors.lastname: Hruda
authors.forename: Ludwig K
authors.initials: LK
authors.lastname: von Segesser
authors.forename: Erik J
authors.initials: EJ
authors.lastname: Meijboom
authors.forename: Mark G
authors.initials: MG
authors.lastname: Hazekamp
mesh_terms: D000293:Adolescent; D000818:Animals; D002417:Cattle; D002648:Child; D002675:Child, Preschool; D004452:Echocardiography; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007601:Jugular Veins / Q000637:transplantation*; D018633:Pulmonary Atresia / Q000601:surgery*; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D016019:Survival Analysis; D014183:Transplantation, Heterologous / Q000401:mortality; D016896:Treatment Outcome; D014338:Truncus Arteriosus / Q000601:surgery*; D018497:Ventricular Dysfunction, Right