Comparison of bovine jugular vein with pulmonary homograft conduits in children less than 2 years of age

• Published in: European journal of cardio-thoracic surgery 2010-09, Vol.38 (3), p.318-325
• Main Authors: Fiore, Andrew C., Ruzmetov, Mark, Huynh, Danny, Hanley, Seth, Rodefeld, Mark D., Turrentine, Mark W., Brown, John W.
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Bioprosthesis; Blood Vessel Prosthesis Implantation - methods; Cardiology. Vascular system; Child, Preschool; Conduits; Epidemiologic Methods; Graft Survival; Heart Defects, Congenital - surgery; Heart Valve Prosthesis Implantation - methods; Heart Ventricles - abnormalities; Heart Ventricles - surgery; Humans; Infant; Infant, Newborn; Jugular Veins - transplantation; Medical sciences; Outcomes; Pneumology; Pulmonary homograft; Pulmonary Valve - transplantation; Pulmonary valve replacement; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Treatment Outcome; Ventricular Outflow Obstruction - etiology
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1016/j.ejcts.2010.01.063

Objectives: The optimal pulmonary valved conduit for infants and small children remains controversial. This report compares the initial insertion outcome of small caliber bovine jugular vein (BJV) (12–14 mm) with pulmonary homografts (PHs) (10–15 mm) in patients under age 2. Methods: From December 1998 to August 2009, 84 children (mean age 8.4 ± 8.5 months) received BJV (n = 51) or PH (n = 32) conduits. Mean Z score for BJV was 2.2 (range: −0.8 to 3.3) and for PH 2.1 (range: 0.8–4.2; P = 0.2). The two cohorts were similar with respect to age, BSA, conduit indication, bypass and cross-clamp time. Graft dysfunction is defined as right ventricular outflow tract obstruction with peak echo-Doppler gradient >40 mmHg and/or grade III/IV conduit valve regurgitation. Graft failure is defined as need for conduit replacement or need for catheter or surgical re-intervention. Follow-up was greater in number in homografts (BJV, 4.4 ± 3.0 years vs PH, 5.9 ± 3.6 years; P = 0.05). Results: Early and late mortality were similar (BJV, 80%; PH 88%; P = 0.55). No death was graft related. Freedom from dysfunction was improved at 5 and 10 years with BJV (BJV, 90% at 85% vs PH, 71% and 24% P ≪ 0.05). Conduit failure trended higher in the PH cohort at 5 and 10 years (BJV, 85% and 67% vs PH, 75% and 45%; P = 0.06). Freedom from explantation was significantly better for BJV patients (BJV, 85% vs PH, 47% P ≪ 0.001. Freedom from distal conduit stenosis was similar (BJV, 52% vs PH, 44% P = 0.36). Conclusions: This study suggests that the early performance of small BJV may be more advantageous than homografts. A BJV conduit is an appropriate first choice for conduit replacement in patients less than 2 years of age.