Bovine Valved Xenograft in Pulmonary Position: Medium-Term Follow-Up With Excellent Hemodynamics and Freedom From Calcification

Abstract

Background This study was designed to evaluate the outcome of Contegra xenograft valved conduit (Contegra, Medtronic Inc, Minneapolis, MN). Methods From April 1999 to December 2003, 67 patients with a mean age of 16.1 ±15.0 years (2 months to 53 years) and a mean weight of 39.7 ± 27.1 kg (4 to 95 kg) were discharged after implantation of a Contegra conduit. The diagnosis contained the following: pulmonary valve replacement during Ross operation (n = 27), pulmonary valve regurgitation (n = 9), tetralogy of Fallot (n = 7), pulmonary atresia with ventricular septal defect (n = 7), double outlet right ventricle (n = 7), truncus arteriosus (n = 5), Taussig-Bing (n = 2), obstructed conduit (n = 2), and double discordance (n = 1). Conduit size was 14 mm in 2, 16 mm in 7, 18 mm in 12, 20 mm in 13, and 22 mm in 33 patients. Mean cardiopulmonary bypass was 155 ± 48 min (65 to 337 min) and mean aortic cross clamping was 69 ± 38 min (0 to 146 min). All patients underwent echocardiography, 23 of 67 (34%) patients had cardiac catheterization, and 23 of 67 (34%) patients had electrocardiograph-gated multislice computer tomography. Results In a mean follow-up of 26.4 months (1 to 56 months) there was one late death (1 of 67 patients; 1.5% mortality) unrelated to the conduit. Five patients underwent reoperation; four were nonconduit-related and one was to replace a twisted conduit. Five patients underwent interventional cardiology; three were nonconduit-related and two were to stent a twisted or stenotic conduit. Echocardiography showed absent valve regurgitation in 30 of 67 (45%) patients, trivial in 21 of 67 (31%) patients, mild in 16 of 67 (24%) patients. The transconduit pressure gradient remained stable during follow-up, with peak pressure gradient 17 ± 11 mm Hg and mean gradient 8 ± 6 mm Hg. Internal diameters corresponded to 110% ± 20% of the implanted diameter at level of proximal anastomosis, 112% ± 18% at valve level, and 110% ± 14% at distal anastomosis. Calcifications were not found, with the exception of a minimal (2.3 mm) parietal calcification. Conclusions The Contegra valved conduit provided excellent morphology and hemodynamics, and freedom from calcification in a medium-term follow-up.