title: Risk factors for development of endocarditis and reintervention in patients undergoing right ventricle to pulmonary artery valved conduit placement.
abstract: OBJECTIVE
  To determine the incidence and risk factors for endocarditis and reintervention in patients undergoing placement of right ventricle-to-pulmonary artery valve conduits.
  
  
  METHODS
  All right ventricle-to-pulmonary artery valved conduits placed between 1995 and 2014 were included. Freedom from endocarditis, reintervention, and replacement were analyzed using the Kaplan-Meier method and parametric survival regression models.
  
  
  RESULTS
  A total of 586 patients underwent placement of a total of 792 valved conduits, including 289 (36%) pulmonary homografts, 121 (15%) aortic homografts, 245 (31%) bovine jugular grafts, and 137 (17%) porcine heterografts. There were 474 (60%) primary placements and 318 (40%) replacements. The median duration of conduit follow-up was 7 years; 23 conduits developed endocarditis at a median of 5 years after surgery. The use of bovine jugular grafts was the sole significant risk factor associated with endocarditis (hazard ratio, 9.05; 95% confidence interval, 2.6-31.8 compared with homografts). The hazard was greater for bovine jugular grafts compared with the other conduit types and increased with time; however, bovine jugular grafts were associated with a lower risk for reintervention (P < .0001) and replacement (P = .0002). Factors associated with greater risk of both reintervention and replacement were younger age and smaller conduit size. In addition, a diagnosis of truncus arteriosus was associated with a greater risk for replacement (P = .03).
  
  
  CONCLUSIONS
  Bovine jugular grafts are associated with a significantly greater risk of late endocarditis but with lower reintervention rates compared with other valved conduits. The risk of endocarditis and durability must be balanced during conduit selection. Antibiotic prophylaxis and a high index of suspicion for endocarditis are warranted in patients with bovine jugular grafts.
authors.affiliation: Division of Congenital Heart Surgery, Texas Children's Hospital, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex. Electronic address: cmmery@texaschildrens.org.
authors.forename: Carlos M
authors.initials: CM
authors.lastname: Mery
authors.affiliation: Division of Congenital Heart Surgery, Texas Children's Hospital, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex.
authors.forename: Francisco A
authors.initials: FA
authors.lastname: Guzmán-Pruneda
authors.affiliation: Division of Congenital Heart Surgery, Texas Children's Hospital, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex; Tecnológico de Monterrey Medical School, Monterrey, Mexico.
authors.forename: Luis E
authors.initials: LE
authors.lastname: De León
authors.affiliation: Outcomes and Impact Service, Texas Children's Hospital, Houston, Tex.
authors.forename: Wei
authors.initials: W
authors.lastname: Zhang
authors.affiliation: University of Texas Medical School, Houston, Tex.
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Terwelp
authors.affiliation: Division of Infectious Diseases, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex.
authors.forename: Claire E
authors.initials: CE
authors.lastname: Bocchini
authors.affiliation: Division of Congenital Heart Surgery, Texas Children's Hospital, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex.
authors.forename: Iki
authors.initials: I
authors.lastname: Adachi
authors.affiliation: Division of Congenital Heart Surgery, Texas Children's Hospital, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex.
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Heinle
authors.affiliation: Division of Congenital Heart Surgery, Texas Children's Hospital, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex.
authors.forename: E Dean
authors.initials: ED
authors.lastname: McKenzie
authors.affiliation: Division of Congenital Heart Surgery, Texas Children's Hospital, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex.
authors.forename: Charles D
authors.initials: CD
authors.lastname: Fraser
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D064591:Allografts; D000818:Animals; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001705:Bioprosthesis; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation / Q000401:mortality; D002417:Cattle; D002648:Child; D002675:Child, Preschool; D000080041:Congenitally Corrected Transposition of the Great Arteries; D020878:Device Removal / Q000009:adverse effects / Q000401:mortality; D018572:Disease-Free Survival; D004697:Endocarditis, Bacterial / Q000175:diagnosis / Q000382:microbiology* / Q000401:mortality / Q000628:therapy*; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation / Q000401:mortality; D006352:Heart Ventricles / Q000503:physiopathology / Q000601:surgery*; D064593:Heterografts; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D011475:Prosthesis Failure; D011651:Pulmonary Artery / Q000503:physiopathology / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013552:Swine; D013997:Time Factors; D014188:Transposition of Great Vessels / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: Contegra; Hancock; bovine jugular vein; conduit; endocarditis; heterograft; homograft; right ventricular outflow tract