Comparison of bovine jugular vein with pulmonary homograft conduits in children less than 2 years of age.
OBJECTIVE
The optimal pulmonary valved conduit for infants and small children remains controversial. This report compares the initial insertion outcome of small caliber bovine jugular vein (BJV) (12-14 mm) with pulmonary homografts (PHs) (10-15 mm) in patients under age 2.


METHODS
From December 1998 to August 2009, 84 children (mean age 8.4 + or - 8.5 months) received BJV (n=51) or PH (n=32) conduits. Mean Z score for BJV was 2.2 (range: -0.8 to 3.3) and for PH 2.1 (range: 0.8-4.2; P=0.2). The two cohorts were similar with respect to age, BSA, conduit indication, bypass and cross-clamp time. Graft dysfunction is defined as right ventricular outflow tract obstruction with peak echo-Doppler gradient >40 mmHg and/or grade III/IV conduit valve regurgitation. Graft failure is defined as need for conduit replacement or need for catheter or surgical re-intervention. Follow-up was greater in number in homografts (BJV, 4.4 + or - 3.0 years vs PH, 5.9+/-3.6 years; P=0.05).


RESULTS
Early and late mortality were similar (BJV, 80%; PH 88%; P=0.55). No death was graft related. Freedom from dysfunction was improved at 5 and 10 years with BJV (BJV, 90% at 85% vs PH, 71% and 24% P<0.05). Conduit failure trended higher in the PH cohort at 5 and 10 years (BJV, 85% and 67% vs PH, 75% and 45%; P=0.06). Freedom from explantation was significantly better for BJV patients (BJV, 85% vs PH, 47% P<0.001. Freedom from distal conduit stenosis was similar (BJV, 52% vs PH, 44% P=0.36).


CONCLUSIONS
This study suggests that the early performance of small BJV may be more advantageous than homografts. A BJV conduit is an appropriate first choice for conduit replacement in patients less than 2 years of age.
Fiore
Andrew C
AC
Divisions of Cardiothoracic Surgery, St. Louis University School of Medicine/Cardinal Glennon Children's Hospital, St. Louis, MO, USA. fiorem2@slu.edu
Ruzmetov
Mark
M
Huynh
Danny
D
Hanley
Seth
S
Rodefeld
Mark D
MD
Turrentine
Mark W
MW
Brown
John W
JW
D001705:Bioprosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D002675:Child, Preschool; D004812:Epidemiologic Methods; D006085:Graft Survival; D006330:Heart Defects, Congenital / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000379:methods; D006352:Heart Ventricles / Q000002:abnormalities / Q000601:surgery; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007601:Jugular Veins / Q000637:transplantation*; D011664:Pulmonary Valve / Q000637:transplantation*; D016896:Treatment Outcome; D014694:Ventricular Outflow Obstruction / Q000209:etiology