title: Incidence and risk factors for Contegra graft infection following right ventricular outflow tract reconstruction: long-term results.
abstract: OBJECTIVE
  The aim of this study was to evaluate the risk factors associated with Contegra graft (Medtronic Minneapolis, MN, USA) infection after reconstruction of the right ventricular outflow tract.
  
  
  METHODS
  One hundred and six Contegra grafts were implanted between April 1999 and April 2010 for the Ross procedure (n = 46), isolated pulmonary valve replacement (n = 32), tetralogy of Fallot (n = 24), double-outlet right ventricle (n = 7), troncus arteriosus (n = 4), switch operation (n = 1) and redo of pulmonary valve replacement (n = 2). The median age of the patients was 13 years (range 0-54 years). A follow-up was completed in all cases with a median duration of 7.6 years (range 1.7-12.7 years).
  
  
  RESULTS
  There were 3 cases of in-hospital mortality. The survival rate during 7 years was 95.7%. Despite the lifelong endocarditis prophylaxis, Contegra graft infection was diagnosed in 12 (11.3%) patients at a median time of 4.4 years (ranging from 0.4 to 8.7 years). Univariate analysis of preoperative, perioperative and postoperative variables was performed and the following risk factors for time to infection were identified: female gender with a hazard ratio (HR) of 0.19 (P = 0.042), systemic-to-pulmonary shunt (HR 6.46, P < 0.01), hypothermia (HR 0.79, P = 0.014), postoperative renal insufficiency (HR 11.97, P = 0.015) and implantation of permanent pacemaker during hospitalization (HR 5.29, P = 0.075). In 2 cases, conservative therapy was successful and, in 10 patients, replacement of the infected valve was performed. The Contegra graft was replaced by a homograft in 2 cases and by a new Contegra graft in 8 cases. Cox's proportional hazard model indicated that time to graft infection was significantly associated with tetralogy of Fallot (HR 0.06, P = 0.01), systemic-to-pulmonary shunt (HR 64.71, P < 0.01) and hypothermia (HR 0.77, P < 0.01).
  
  
  CONCLUSIONS
  Contegra graft infection affected 11.3% of cases in our cohort, and thus may be considered as a frequent entity that can be predicted by both intraoperative and early postoperative factors. After the diagnosis of infection associated with the Contegra graft was confirmed, surgical treatment was the therapy of choice.
authors.affiliation: Department of Cardiovascular Surgery, University Hospital, Lausanne, Switzerland.
authors.forename: Frederique
authors.initials: F
authors.lastname: Albanesi
authors.affiliation: Department of Pediatric Cardiology, University Hospital, Lausanne, Switzerland.
authors.forename: Nicole
authors.initials: N
authors.lastname: Sekarski
authors.affiliation: Department of Neurology, University Hospital, Lausanne, Switzerland.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Lambrou
authors.affiliation: Department of Cardiovascular Surgery, University Hospital, Lausanne, Switzerland.
authors.forename: Ludwig K
authors.initials: LK
authors.lastname: Von Segesser
authors.affiliation: Department of Cardiovascular Surgery, University Hospital, Lausanne, Switzerland denis.berdajs@chuv.ch.
authors.forename: Denis A
authors.initials: DA
authors.lastname: Berdajs
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality*; D006801:Humans; D007036:Hypothermia, Induced; D007223:Infant; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000453:epidemiology* / Q000401:mortality; D012307:Risk Factors; D014694:Ventricular Outflow Obstruction / Q000453:epidemiology / Q000601:surgery*; D055815:Young Adult
keywords: Endocarditis; Pulmonary valve; Ross operation; Xenograft