EARLY RESULTS OF BOVINE JUGULAR VEIN CONDUIT VERSUS BICUSPID HOMOGRAFTS FOR RVOT. RECONSTRUCTION

T.Bové, H.Demanet, P.Wauthy, J.P.Goldstein, H.Dessy*, P.Viart*, A.Devillé**, F.E.Deuvaert

Department of Cardiac Surgery, Pediatric Cardiology* and Anesthesiology**
Hôpital Universitaire Des Enfants Reine Fabiola
U.L.B. – V.U.B., Brussels, Belgium

Background : Homograft conduits are used routinely for reconstruction of the right ventricular outflow tract in children. However, despite the successful application of surgical size-reduction to bicuspid conduits, homograft availability remains a major concern, particularly for the small sizes. Recently, a glutaraldehyde preserved segment of bovine jugular vein, integrating a valve (Contegra®, Medtronic Inc.) has been introduced as an alternative conduit for the pulmonary circulation.

Methods : The early results of RVOT repair using a bovine jugular vein conduit in 41 patients (mean age 2.6 y) are compared to 36 patients (mean age 1.9 y) with size-reduced pulmonary homografts (HG). The anatomical malformations are included in the table. Both populations underwent a comparable number of previous procedures : 16 in the HG group vs.19 in the Contegra® group (p=NS). The median conduit size, implanted in both groups was 16 mm.

Results : Clinical outcome was comparable with 2 (6%) early deaths in the HG group and 1 (2%) in the Contegraâgroup (p=NS). There were no conduit-related complications.

Echocardiographic data at discharge showed trivial to mild regurgitation in 9 (HG) vs. 17 pts. (Contegra®)(p=NS). The measured gradient across the RVOT was comparable in both groups, although a larger number of patients had a minor (< 15 mmhg) gradient at the distal conjunction with the pulmonary arteries in the HG group (12 vs. 6 pts, p=0.05). None of the patients had a gradient at valvular level.

Conclusion : Based on these early results, bovine jugular vein conduits seem promising substitutes for RVOT reconstruction in children, with hemodynamics that compare favourably with downsized, bicuspid homografts. But they have the major advantage of larger shelf-availability, especially for the small sizes. However, longer-term follow-up is necessary to ascertain durability, albeit knowing that most of these small children will have reoperation on the right ventricular outflow tract in their near future.