Jugular venous valved conduit (Contegra) matches allograft performance in infant truncus arteriosus repair.
OBJECTIVE
Limited availability and durability of allograft conduits require that alternatives be considered. We compared bovine jugular venous valved (JVV) and allograft conduit performance in 107 infants who survived truncus arteriosus repair.


METHODS
Children were prospectively recruited between 2003 and 2007 from 17 institutions. The median z-score for JVV (n=27, all 12 mm) was +2.1 (range +1.2 to +3.2) and allograft (n=80, 9-15mm) was +1.7 (range -0.4 to +3.6). Propensity-adjusted comparison of conduit survival was undertaken using parametric risk-hazard analysis and competing risks techniques. All available echocardiograms (n=745) were used to model deterioration of conduit function in regression equations adjusted for repeated measures.


RESULTS
Overall conduit survival was 64+/-9% at 3 years. Conduit replacement was for conduit stenosis (n=16) and/or pulmonary artery stenosis (n=18) or regurgitation (n=1). The propensity-adjusted 3-year freedom from replacement for in-conduit stenosis was 96+/-4% for JVV and 69+/-8% for allograft (p=0.05). The risk of intervention or replacement for branch pulmonary artery stenosis was similar for JVV and allograft. Smaller conduit z-score predicted poor conduit performance (p<0.01) with best outcome between +1 and +3. Although JVV conduits were a uniform diameter, their z-score more consistently matched this ideal. JVV exhibited a non-significant trend towards slower progression of conduit regurgitation and peak right ventricular outflow tract (RVOT) gradient. In addition, catheter intervention was more successful at slowing subsequent gradient progression in children with JVV versus those with allograft (p<0.01).


CONCLUSIONS
JVV does match allograft performance and may be advantageous. It is an appropriate first choice for repair of truncus arteriosus, and perhaps other small infants requiring RVOT reconstruction.
Hickey
Edward J
EJ
The Congenital Heart Surgeons' Society Data Center, Toronto, Canada.
McCrindle
Brian W
BW
Blackstone
Eugene H
EH
Yeh
Thomas
T
Pigula
Frank
F
Clarke
David
D
Tchervenkov
Christo I
CI
Hawkins
John
J
D000818:Animals; D001705:Bioprosthesis; D006328:Cardiac Catheterization; D002417:Cattle; D004452:Echocardiography; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007601:Jugular Veins / Q000601:surgery*; D011446:Prospective Studies; D011474:Prosthesis Design; D011475:Prosthesis Failure; D019919:Prosthesis Implantation / Q000379:methods*; D012086:Reoperation; D013995:Time; D014183:Transplantation, Heterologous; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D014338:Truncus Arteriosus / Q000000981:diagnostic imaging / Q000601:surgery*; D014694:Ventricular Outflow Obstruction / Q000000981:diagnostic imaging / Q000601:surgery*