title: Bovine Jugular Veins versus Homografts in the Pulmonary Position: An Analysis across Two Centers and 711 Patients-Conventional Comparisons and Time Status Graphs as a New Approach.
abstract: BACKGROUND
  Various diseases and diversity in implantation ages, together with evolving diagnostic and therapeutic options, hinder comparative evaluations of long-term outcomes for valved conduits used for reconstruction of the right ventricular outflow tract (RVOT). We combined two common evaluation methods to optimally use information obtained by pooling the raw data from two high volume centers, each with very regular follow-up procedures, with the aim of analyzing durability differences between conventional homografts and bovine jugular veins.
  
  
  METHODS
  In the period 1985 to 2012, a total of 444 bovine jugular veins and 267 homografts were implanted, and 6,738 postoperative examinations took place. Evaluations included age-stratified Kaplan-Meier analyses, Cox regression models, and time status graphs, the third showing age-group stratified, time-related frequencies of intact, insufficient, stenotic, both insufficient and stenotic, and postinterventional conduits below the freedom from explantation curve. They take into account interventions, explantations, and the nonterminal character of echocardiographic findings.
  
  
  RESULTS
  The durability of intact bovine jugular veins in children and young adults is not inferior to that of homografts. Averaged over the first 12 years after implantation, the age groups < 25 years in fact showed advantages for bovine jugular vein recipients. The average fraction of patients younger than 25 years whose conduits were not explanted, postinterventional, stenotic, insufficient, or stenotic and insufficient was at least 10% higher in recipients of bovine jugular veins than in homograft recipients.
  
  
  CONCLUSIONS
  According to the time status graphs, the use of bovine jugular veins for RVOT in patients younger than 25 years appears to lead to superior results when compared with cryopreserved homografts.
authors: Clinic of Surgery for Congenital Heart Defects, Center for Congenital Heart Defects, Heart and Diabetes Center North-Rhine Westphalia, Bad Oeynhausen, Germany.
authors: Eugen
authors: E
authors: Sandica
authors: Clinic for Pediatric Cardiology and Pediatric Intensive Care Medicine, Hannover Medical School, Hannover, Germany.
authors: Dietmar
authors: D
authors: Boethig
authors: Clinic of Surgery for Congenital Heart Defects, Center for Congenital Heart Defects, Heart and Diabetes Center North-Rhine Westphalia, Bad Oeynhausen, Germany.
authors: Ute
authors: U
authors: Blanz
authors: Clinic for Pediatric Cardiology and Congenital Heart, Center for Congenital Heart Defects, Heart and Diabetes Center North-Rhine Westphalia, Bad Oeynhausen, Germany.
authors: Rainer
authors: R
authors: Goerg
authors: Clinic for Pediatric Cardiology and Congenital Heart, Center for Congenital Heart Defects, Heart and Diabetes Center North-Rhine Westphalia, Bad Oeynhausen, Germany.
authors: Nikolaus Andreas
authors: NA
authors: Haas
authors: Clinic for Pediatric Cardiology and Congenital Heart, Center for Congenital Heart Defects, Heart and Diabetes Center North-Rhine Westphalia, Bad Oeynhausen, Germany.
authors: Kai Thorsten
authors: KT
authors: Laser
authors: Clinic for Pediatric Cardiology and Congenital Heart, Center for Congenital Heart Defects, Heart and Diabetes Center North-Rhine Westphalia, Bad Oeynhausen, Germany.
authors: Deniz
authors: D
authors: Kececioglu
authors: Clinic for Pediatric Cardiology and Pediatric Intensive Care Medicine, Hannover Medical School, Hannover, Germany.
authors: Harald
authors: H
authors: Bertram
authors: Clinic for Cardiac, Thoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany.
authors: Samir
authors: S
authors: Sarikouch
authors: Clinic for Cardiology and Angiology, Hannover Medical School, Hannover, Germany.
authors: Mechthild
authors: M
authors: Westhoff-Bleck
authors: Clinic for Pediatric Cardiology and Pediatric Intensive Care Medicine, Hannover Medical School, Hannover, Germany.
authors: Philipp
authors: P
authors: Beerbaum
authors: Clinic for Cardiac, Thoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany.
authors: Alexander
authors: A
authors: Horke
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D064591:Allografts; D000818:Animals; D001705:Bioprosthesis; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods / Q000401:mortality; D002417:Cattle; D002648:Child; D002675:Child, Preschool; D020878:Device Removal; D005260:Female; D005858:Germany; D006085:Graft Survival; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods / Q000401:mortality; D064593:Heterografts; D061847:Hospitals, High-Volume; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007601:Jugular Veins / Q000637:transplantation*; D053208:Kaplan-Meier Estimate; D008297:Male; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011474:Prosthesis Design; D011475:Prosthesis Failure; D011651:Pulmonary Artery / Q000637:transplantation*; D011664:Pulmonary Valve / Q000637:transplantation*; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult