title: A bovine jugular vein conduit: a ten-year bi-institutional experience.
abstract: BACKGROUND
  We retrospectively reviewed the 12-year (1999 to 2010) clinical and echocardiographic performance of 232 bovine jugular vein conduits for extracardiac right ventricular outflow tract reconstruction in non-Ross patients.
  
  
  METHODS
  The bovine jugular vein conduit cohorts, group 1 (12 to 14 mm), group 2 (16 to 18 mm), and group 3 (20 to 22 mm), had mean follow-up of 48 ± 30 months. Graft dysfunction is defined as right ventricular outflow tract obstruction with peak echo Doppler gradient greater than 40 mm Hg or grade 3/4 valve regurgitation. Graft failure is the need for conduit replacement or transcatheter or surgical reintervention.
  
  
  RESULTS
  Early mortality (4 of 232; 2%) and late mortality (8 of 228; 3.5%) were not conduit related. Twenty-four conduits (10%) were explanted. Mean implant Z score was significantly lower for group 1 (1.7±0.08 versus group 2, 2.7±0.6, or group 3, 2.5±1.5; p=0.001). Ten-year actuarial survival (group 1, 84% versus 2, 100%, and 3, 99%; p=0.001) and freedom from conduit dysfunction (group 1, 64%; group 2, 92%; and group 3, 90%) and failure (group 1, 75%; 2, 82%; and 3, 91%; p=0.002) were significantly better for groups 2 and 3.
  
  
  CONCLUSIONS
  Bovine jugular vein is an excellent immediate substitute for right ventricular outflow tract reconstruction, with early durability superior to that of pulmonary homografts reported at similar follow-up. Conduits larger than 14 mm have improved performance. Longer follow-up will define the structural integrity and efficacy of this prosthesis.
authors.affiliation: Division of Cardiothoracic Surgery, Saint Louis University School of Medicine, Cardinal Glennon Children's Hospital, St. Louis, Missouri 63104, USA. fiorem2@slu.edu
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Fiore
authors.forename: John W
authors.initials: JW
authors.lastname: Brown
authors.forename: Mark W
authors.initials: MW
authors.lastname: Turrentine
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
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000714:Anastomosis, Surgical / Q000379:methods; D000818:Animals; D002417:Cattle; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007601:Jugular Veins / Q000601:surgery / Q000637:transplantation*; D053208:Kaplan-Meier Estimate; D008297:Male; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D014694:Ventricular Outflow Obstruction / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D055815:Young Adult