Risk factors for early adverse outcomes after bovine jugular vein conduit implantation: influence of oversized conduit on the outcomes. (27th July 2022)

• Record Type: Journal Article
• Authors: Kim, Dong-Hee; Kwon, Young Kern; Choi, Eun Seok; Kwon, Bo Sang; Park, Chun Soo; Yun, Tae-Jin
• Is Part Of: Interactive cardiovascular and thoracic surgery. Volume 35:Number 4(2022)
• Publication Date: 2022-07-27
• Subjects: Bovine jugular vein conduit -- Contegra -- Right ventricular outflow tract -- Explantation -- Endocarditis; Chest -- Surgery -- Periodicals; Cardiovascular system -- Diseases -- Periodicals; 616.1
• DOI: 10.1093/icvts/ivac197
• Languages: English
• ISSNs: 1569-9293

Abstract

Abstract: OBJECTIVES: We investigated potential risk factors for early failure of bovine jugular vein conduit (Contegra ® ) implantation for right ventricular outflow tract (RVOT) reconstruction. METHODS: A single-centre retrospective review of 115 consecutive patients (54 males) who underwent RVOT reconstruction with Contegra between 2016 and 2019 was performed. Overall survival, explantation-free survival and freedom from significant RVOT lesions (valve regurgitation ≥ moderate or flow velocity ≥3.5 m/s) were investigated. RESULTS: Median age, body weight and Contegra diameter were 10.3 months [interquartile range (IQR) 5.7–26.9 months], 7.8 kg (IQR 6.3–12.4 kg) and 14 mm (IQR 12–16 mm), respectively. During the median follow-up duration of 25.1 months, there were 7 deaths, 34 significant RVOT lesions, 10 endocarditis episodes and 15 explantations. Overall survival and explantation-free survival at 3 years were 94.8% and 78.4%, respectively. Significant RVOT lesions ( n = 34) comprised 20 stenoses, 8 regurgitations and 6 combined lesions. Freedom from significant RVOT lesions at 3 years was 62.6%. Cox regression identified higher indexed Contegra size (Contegra diameter/body weight, mm/kg) as the only risk factor for decreased time to explantation or death (hazard ratio 2.32, P < 0.001) and time to significant RVOT lesions development (hazard ratio 2.75, P < 0.001). The cut-off value of indexed Contegra size for significant RVOT lesions at 12 months was 1.905 mm/kg (sensitivity, 0.75; specificity, 0.78; area under the curve, 0.82). CONCLUSIONS: Outcomes of RVOT reconstruction using Contegra were acceptable. However, oversized Contegra should be avoided when possible. IRB APPROVAL DATE: 26 October 2020. IRB REGISTRATION NUMBER: S2020-2505-0001 Abstract : The surgical treatment of various congenital heart diseases frequently entails reconstruction of the right ventricular outflow tract (RVOT) using a conduit.