Contegra Versus Pulmonary Homografts for Right Ventricular Outflow Tract Reconstruction: A Ten-Year Single-Institution Comparison

Abstract

Repair of congenital heart defects involving the right ventricular outflow tract (RVOT) may require pulmonary valve replacement at the time of primary repair or reoperation. This study compares the outcomes of bovine jugular vein grafts (BJV, Contegra, Medtronic Inc.) with cryopreserved pulmonary homografts (PHs) in patients with RVOT obstruction at a single institution. We reviewed the outcomes of all BJVs and PHs implanted for RVOT reconstruction from 1999 to 2010. Echocardiographic data were reviewed to evaluate valve performance. Graft dysfunction is defined as RVOT obstruction with peak echo-Doppler gradient >40 mm Hg and/or grade III/IV conduit valve regurgitation. Graft failure is defined as need for conduit replacement or need for catheter or surgical reintervention. A total of 216 patients who received BJVs (n = 153) and PHs (n = 63) were studied. There was no significant difference between the groups with respect to mean age, body surface area, conduit indication, or conduit diameter, though mean follow-up duration was longer in patients that received homografts. Conduit dysfunction and conduit failure and need for explantation were worse for homografts, albeit at longer follow-up interval. Distal stenosis and actuarial survival were similar. In the first ten years after pulmonary implantation of BJVs and PHs, survival and freedom from distal stenosis are statistically similar, but freedom from failure, dysfunction, and explantation are significantly better for BJV conduits. The BJV conduit is a good alternative in patients who require RVOT reconstruction.