Original article
Congenital heart surgery
An Increased Incidence of Conduit Endocarditis in Patients Receiving Bovine Jugular Vein Grafts Compared to Cryopreserved Homograft for Right Ventricular Outflow Reconstruction

https://doi.org/10.1016/j.athoracsur.2014.08.034Get rights and content

Background

We compared the outcome of patients receiving bovine jugular vein grafts versus cryopreserved homografts for right ventricular outflow tract reconstruction.

Methods

Between 2000 and 2012, 379 conduits (244 bovine jugular vein grafts, 135 homografts) were implanted in 298 patients (median age 50 months) with a median follow-up of 3.4 years.

Results

Freedom from reoperation at 1, 5, and 7 years was 96.3%, 79.3%, and 64.2% after bovine jugular vein graft and 94.6%, 75.7%, and 68.6% after homograft insertion (p = 0.086). There were 24 cases of endocarditis, 23 associated with bovine jugular vein grafts (9.4%) and 1 associated with a homograft (0.7%; p < 0.001) at median follow-up of 44 months (range, 15 days to 10 years) after conduit implantation. After endocarditis, 15 of 24 conduits were replaced. Three patients had recurrent endocarditis in the revised conduit. Multivariate logistic regression analysis showed age less than 3 years and endocarditis to be significant risk factors associated with conduit replacement. Age more than 3 years and bovine jugular vein grafts were significant risk factors for graft endocarditis. Patients more than 3 years of age at bovine jugular vein graft implantation had significantly lower freedom from reoperation (p = 0.01).

Conclusions

Compared with homograft conduits, the use of bovine jugular vein grafts for right ventricular outflow tract reconstruction was associated with a significantly higher incidence of bacterial endocarditis and conduit deterioration in older children at our institution. That may influence decision making regarding conduit choice for right ventricular outflow tract reconstruction. Patients and practitioners should be aware of the late risks of bacterial endocarditis after bovine jugular vein graft implantation.

Section snippets

Patients

We performed a retrospective review of all available clinical data for patients who underwent RVOT reconstruction using BJV grafts or cryopreserved homografts at our institution between January 2000 and August 2012. The University of Alberta Institutional Review Board approved the study, and the need for parental consent was waived. The choice of conduit was based on appropriate size availability of homografts or surgeon preference.

Right Ventricular Outflow Tract Reconstruction

Conduit implantation was usually performed on an empty beating

Results

We implanted 379 RV-PA conduits in 298 patients using either BJV grafts (n = 244) or cryopreserved homografts (n = 135) during the study period. The median age at RVOT reconstruction was 4 years (range, 1 day to 50 years). The median follow-up after RVOT reconstruction was 3.4 years (range, 2 days to 12 years). The median follow-up after BJV grafts was 3.2 years (range, 2 days to 11.7 years). The median follow-up after homografts was 4.3 years (range, 5 days to 11.6 years). Of the 135

Comment

The main finding of our study was a higher incidence of endocarditis late after RVOT reconstruction with BJV grafts compared with homografts, especially in children older than 3 years. Endocarditis appears to precipitate graft failure and the need for reoperation after insertion of BJV grafts in the pulmonary position. In addition, the overall freedom from reoperation was similar whether BJV grafts or homografts were used for RVOT reconstruction. Age less than 3 years at graft insertion was

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