title: An increased incidence of conduit endocarditis in patients receiving bovine jugular vein grafts compared to cryopreserved homograft for right ventricular outflow reconstruction.
abstract: BACKGROUND
  We compared the outcome of patients receiving bovine jugular vein grafts versus cryopreserved homografts for right ventricular outflow tract reconstruction.
  
  
  METHODS
  Between 2000 and 2012, 379 conduits (244 bovine jugular vein grafts, 135 homografts) were implanted in 298 patients (median age 50 months) with a median follow-up of 3.4 years.
  
  
  RESULTS
  Freedom from reoperation at 1, 5, and 7 years was 96.3%, 79.3%, and 64.2% after bovine jugular vein graft and 94.6%, 75.7%, and 68.6% after homograft insertion (p = 0.086). There were 24 cases of endocarditis, 23 associated with bovine jugular vein grafts (9.4%) and 1 associated with a homograft (0.7%; p < 0.001) at median follow-up of 44 months (range, 15 days to 10 years) after conduit implantation. After endocarditis, 15 of 24 conduits were replaced. Three patients had recurrent endocarditis in the revised conduit. Multivariate logistic regression analysis showed age less than 3 years and endocarditis to be significant risk factors associated with conduit replacement. Age more than 3 years and bovine jugular vein grafts were significant risk factors for graft endocarditis. Patients more than 3 years of age at bovine jugular vein graft implantation had significantly lower freedom from reoperation (p = 0.01).
  
  
  CONCLUSIONS
  Compared with homograft conduits, the use of bovine jugular vein grafts for right ventricular outflow tract reconstruction was associated with a significantly higher incidence of bacterial endocarditis and conduit deterioration in older children at our institution. That may influence decision making regarding conduit choice for right ventricular outflow tract reconstruction. Patients and practitioners should be aware of the late risks of bacterial endocarditis after bovine jugular vein graft implantation.
authors.affiliation: Division of Pediatric Cardiac Surgery, Stollery Children's Hospital, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Shinya
authors.initials: S
authors.lastname: Ugaki
authors.affiliation: Division of Pediatric Cardiology, Stollery Children's Hospital, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Rutledge
authors.affiliation: Division of Pediatric Cardiac Surgery, Stollery Children's Hospital, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Al Aklabi
authors.affiliation: Division of Pediatric Cardiac Surgery, Stollery Children's Hospital, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: David B
authors.initials: DB
authors.lastname: Ross
authors.affiliation: Division of Pediatric Cardiology, Stollery Children's Hospital, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada; Division of Pediatric Cardiac Critical Care, Stollery Children's Hospital, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada. Electronic address: iadatia@ualberta.ca.
authors.forename: Ian
authors.initials: I
authors.lastname: Adatia
authors.affiliation: Division of Pediatric Cardiac Surgery, Stollery Children's Hospital, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Ivan M
authors.initials: IM
authors.lastname: Rebeyka
mesh_terms: D000293:Adolescent; D000328:Adult; D064591:Allografts; D000818:Animals; D002417:Cattle; D002648:Child; D002675:Child, Preschool; D015925:Cryopreservation; D004696:Endocarditis / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007601:Jugular Veins / Q000637:transplantation*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D014694:Ventricular Outflow Obstruction / Q000601:surgery*; D055815:Young Adult