title: Comparison of bovine jugular vein with pulmonary homograft conduits in children less than 2 years of age.
abstract: 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.
authors.affiliation: Divisions of Cardiothoracic Surgery, St. Louis University School of Medicine/Cardinal Glennon Children's Hospital, St. Louis, MO, USA. fiorem2@slu.edu
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Fiore
authors.forename: Mark
authors.initials: M
authors.lastname: Ruzmetov
authors.forename: Danny
authors.initials: D
authors.lastname: Huynh
authors.forename: Seth
authors.initials: S
authors.lastname: Hanley
authors.forename: Mark D
authors.initials: MD
authors.lastname: Rodefeld
authors.forename: Mark W
authors.initials: MW
authors.lastname: Turrentine
authors.forename: John W
authors.initials: JW
authors.lastname: Brown
mesh_terms: 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