The Contegra bovine jugular vein graft versus the Shelhigh pulmonic porcine graft for reconstruction of the right ventricular outflow tract: a comparative study.
OBJECTIVE
Reconstruction of the right ventricular outflow tract plays a major role in congenital cardiac surgery. With the advent of the Contegra bovine jugular vein graft and the Shelhigh pulmonic xenograft, hopes were high that the lack of availability of homografts would be overcome. The present study evaluated both grafts and investigated the influence of known risk factors for premature graft failure.


METHODS
From December 1999 to September 2008, 84 consecutive patients (mean age, 12 ± 15 years) with a total of 100 implanted conduits (43 Contegra bovine jugular vein grafts and 57 Shelhigh pulmonic xenografts) were included in this study. Primary end points were reintervention, reoperation, and death.


RESULTS
The rate of overall conduit replacement was 25% for the Shelhigh pulmonic xenograft versus 26% for the Contegra bovine jugular vein graft. The predominant mode of failure was conduit stenosis for both groups (23% for the Shelhigh pulmonic xenograft vs 19% for the Contegra bovine jugular vein graft), with a mean time to replacement of 18 ± 9 months for the Shelhigh pulmonic xenograft versus 42 ± 4 months for the Contegra bovine jugular vein graft (P = .25). Histopathological analysis revealed a similar chronic inflammatory reaction in both conduits, but it was significantly stronger in the Shelhigh pulmonic xenograft group. The Contegra bovine jugular vein graft showed frequently the formation of a stenotic membrane at the distal anastomosis site. Age of less than 1 year, body surface area, pulmonary stenosis, and conduit size of less than 14 mm could not be identified as risk factors for premature failure.


CONCLUSIONS
Both conduits fail predominantly because of stenosis and are subject to a chronic inflammatory reaction, although this was stronger in the Shelhigh pulmonic xenograft group. Mean time to replacement was 18 ± 9 months for the Shelhigh pulmonic graft group versus 42 ± 4 months for the Contegra bovine graft group (P = .25). Because there is a trend toward earlier failure in the Shelhigh pulmonic xenograft group, we currently prefer to implant the Contegra bovine jugular vein graft for right ventricular outflow tract reconstruction.
Department of Cardiovascular Surgery, University Hospital Berne, University Berne, Switzerland.
Florian S
FS
Schoenhoff
Ophelie
O
Loup
Brigitta
B
Gahl
Yara
Y
Banz
Mladen
M
Pavlovic
Jean-Pierre
JP
Pfammatter
Thierry P
TP
Carrel
Alexander
A
Kadner
D000293:Adolescent; D000328:Adult; D000818:Animals; D001705:Bioprosthesis; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002417:Cattle; D002648:Child; D002675:Child, Preschool; D003251:Constriction, Pathologic; D020878:Device Removal; D006083:Graft Occlusion, Vascular / Q000209:etiology / Q000473:pathology / Q000601:surgery; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007601:Jugular Veins / Q000637:transplantation*; D053208:Kaplan-Meier Estimate; D016016:Proportional Hazards Models; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012086:Reoperation; D018570:Risk Assessment; D012307:Risk Factors; D013552:Swine; D013557:Switzerland; D013997:Time Factors; D016896:Treatment Outcome; D014694:Ventricular Outflow Obstruction / Q000401:mortality / Q000601:surgery*; D055815:Young Adult