Risk factors for development of endocarditis and reintervention in patients undergoing right ventricle to pulmonary artery valved conduit placement

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 151; no. 2; pp. 432 - 441.e2
• Main Authors: Mery, Carlos M., MD, MPH, Guzmán-Pruneda, Francisco A., MD, De León, Luis E., MD, Zhang, Wei, PhD, Terwelp, Matthew D., BS, Bocchini, Claire E., MD, Adachi, Iki, MD, Heinle, Jeffrey S., MD, McKenzie, E. Dean, MD, Fraser, Charles D., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.02.2016
• Subjects: Adolescent; Adult; Age Factors; Allografts; Animals; Anti-Bacterial Agents - therapeutic use; Bioprosthesis; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation - adverse effects; Blood Vessel Prosthesis Implantation - instrumentation; Blood Vessel Prosthesis Implantation - mortality; bovine jugular vein; Cardiothoracic Surgery; Cattle; Child; Child, Preschool; conduit; Contegra; Device Removal - adverse effects; Device Removal - mortality; Disease-Free Survival; endocarditis; Endocarditis, Bacterial - diagnosis; Endocarditis, Bacterial - microbiology; Endocarditis, Bacterial - mortality; Endocarditis, Bacterial - therapy; Female; Hancock; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation - adverse effects; Heart Valve Prosthesis Implantation - instrumentation; Heart Valve Prosthesis Implantation - mortality; Heart Ventricles - physiopathology; Heart Ventricles - surgery; heterograft; Heterografts; homograft; Humans; Infant; Infant, Newborn; Kaplan-Meier Estimate; Male; Middle Aged; Prosthesis Design; Prosthesis Failure; Pulmonary Artery - physiopathology; Pulmonary Artery - surgery; Reoperation; Retrospective Studies; right ventricular outflow tract; Risk Factors; Swine; Time Factors; Transposition of Great Vessels - diagnosis; Transposition of Great Vessels - mortality; Transposition of Great Vessels - physiopathology; Transposition of Great Vessels - surgery; Treatment Outcome; Young Adult; CRP; erythrocyte sedimentation rate; C-reactive protein; ESR; CI; PA/VSD; Contegra; Hancock; HR; standard error; conduit; methicillin-sensitive Staphylococcus aureus; right ventricular outflow tract; pulmonary atresia with ventricular septal defect; bovine jugular vein; MSSA; SE; heterograft; hazard ratio; endocarditis; homograft; confidence interval
• DOI: 10.1016/j.jtcvs.2015.10.069
• ISSN: 0022-5223

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.