title: Medium-term outcomes of bovine jugular vein graft and homograft conduits in children.
abstract: BACKGROUND
  The bovine jugular vein (Contegra) conduit has been described as an alternative to the homograft for right ventricle (RV) to pulmonary artery (PA) connection. We assessed the outcomes of Contegra conduits and homografts at a single institution.
  
  
  METHODS
  We conducted a retrospective review of children (n = 249) who underwent RV-to-PA conduit (Contegra or homograft) implantation from 2001 to 2011.
  
  
  RESULTS
  Median operation age was 4.8 years (2 days-18 years). Indications for surgery were as follows: primary conduit insertion (n = 131; 53%), previous conduit failure (n = 57; 23%) or Ross procedure (n = 61; 25%). There were 113 (45%) Contegra conduits and 136 (55%) homografts (92 pulmonary, 44 aortic) inserted. Early mortality was 5% (n = 12). Overall survival was 89% (95% confidence interval (CI): 84-92%) at 5 years and 87% (95% CI: 81-92%) at 10 years. Mortality was associated with smaller conduit size (P = 0.044) and syndrome diagnosis (P = 0.012). Freedom from reoperation was 85% (95% CI: 77-91%) and 75% (95% CI: 59-86%) at 5 years for homografts and Contegra conduits, respectively. Patients required conduit replacement (15%) for endocarditis (n = 4; 11%) or graft failure (n = 34; 89%). Eleven patients developed distal conduit stenosis with the majority occurring in Contegra conduits (n = 7; 64%) (P = 0.004). A larger conduit (P = 0.007) was protective against reoperation. There was no difference in reoperation between conduits (P = 0.41). Mean follow-up was 5 ± 3.2 years (96% complete). Majority of survivors (99%) were in New York Heart Association Class II/I.
  
  
  CONCLUSIONS
  The Contegra conduit and homograft demonstrate similar mid-term outcomes in children. Smaller conduit size is associated with higher graft failure and mortality.
authors.affiliation: Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Victoria, Australia.
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Yong
authors.forename: Deane
authors.initials: D
authors.lastname: Yim
authors.forename: Yves
authors.initials: Y
authors.lastname: d'Udekem
authors.forename: Christian P
authors.initials: CP
authors.lastname: Brizard
authors.forename: Terry
authors.initials: T
authors.lastname: Robertson
authors.forename: John C
authors.initials: JC
authors.lastname: Galati
authors.forename: Igor E
authors.initials: IE
authors.lastname: Konstantinov
mesh_terms: D000293:Adolescent; D000818:Animals; D001011:Aorta / Q000637:transplantation; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods* / Q000401:mortality; D002417:Cattle; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000401:mortality / Q000601:surgery*; D006352:Heart Ventricles / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007601:Jugular Veins / Q000637:transplantation*; D008297:Male; D011651:Pulmonary Artery / Q000601:surgery* / Q000637:transplantation; D012189:Retrospective Studies; D016019:Survival Analysis; D014183:Transplantation, Heterologous / Q000379:methods* / Q000401:mortality; D014184:Transplantation, Homologous / Q000379:methods / Q000401:mortality; D016896:Treatment Outcome
keywords: blood vessel prosthesis; congenital heart defect; heart valve prosthesis; homograft; right ventricle