Bovine valved venous xenograft in pulmonary position: medium term evaluation of risk factors for dysfunction and failure after 156 implants

• Published in: Journal of cardiovascular surgery Vol. 52; no. 2; p. 285
• Main Authors: Palma, G, Mannacio, V A, Mastrogiovanni, G, Russolillo, V, Cioffi, S, Mucerino, M, Vosa, C
• Format: Journal Article
• Language: English
• Published: Italy 01.04.2011
• Subjects: Adolescent; Adult; Age Factors; Animals; Cattle; Chi-Square Distribution; Child; Child, Preschool; Female; Heart Defects, Congenital - surgery; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation - adverse effects; Heart Valve Prosthesis Implantation - instrumentation; Heart Valve Prosthesis Implantation - mortality; Hospital Mortality; Humans; Infant; Italy; Kaplan-Meier Estimate; Male; Odds Ratio; Prosthesis Design; Prosthesis Failure; Pulmonary Valve - surgery; Reoperation; Retrospective Studies; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome; Young Adult; Italy
• ISSN: 0021-9509

This study evaluated risk factors for dysfunction and failure of the bovine Contegra valved conduit for right ventricle outflow tract reconstruction. A total of 156 bovine jugular vein conduits were reviewed. Early and late mortality were evaluated. Seriate echocardiography was performed through the follow-up (mean 58±43.2 months, range 12 to 108 months), and risk factors and adverse events evaluation were analyzed by multivariate logistic regression. Hospital mortality was 7% (11/156). The only independent predictor of early mortality were cardiopulmonary bypass time >120 minutes and age <1 year. Postoperative mean RV to PA gradient was 10.4±9.1 mm Hg, increased to 18.7±14.5 mm Hg during the follow-up. A late gradient >30 mm Hg was assessed in 22 patients (15.1%),while 12 patients developed conduit valve regurgitation greater than 2+ without evidence of aneurismal formation. All patients with right ventricular (RV) to left ventricular (LV) pressure ratio >0.6 had conduit valve regurgitation. Acquired distal conduit stenosis was observed only in 1 patient. Thirteen patient underwent conduit replacement, diameter ≤14 mm was the only independent risk factor for reoperation. All explanted conduits were free from calcification and valve leaflets were intact and pliable. The Contegra graft itself was never cause of adverse event. The Contegra conduit provided excellent results and freedom from calcification in a medium-term follow-up. Younger age at operation was associated with higher need of replacements for conduit patient mismatch due to patient growth.