Long-term results of right ventricular outflow tract reconstruction with Contegra®

Abstract

Right ventricular outflow tract reconstruction is a common feature for the treatment of congenital heart disease. However, the best substitute for pulmonary valvulation is still unknown, since the whole valves impair in above ten years. Pulmonary homograft appears to be the best substitute, but the lack of availability of this substitute, especially the low diameter, conducted to the development of other valves, biological or synthetic. The Contegra® valve is a bioprosthesis obtained from bovine jugular vein. Available in diameters from 12 to 22 mm, these conduits should constitute a good alternative to the homograft, especially concerning low weight children. The objective of this study was to describe the long-term evolution of Contegra® in our institution. We conducted a retrospective monocentric observational study at the CHRU of Tours including all patients implanted with a Contegra® valve between January 2001 and December 2018. Over this 17-year period, 58 Contegra® implanted in 52 patients were included (average age 6.7 ± 5.4 years at valvulation). Survival without revision surgery for conduit failure was 87% (95 CI {79–97}) at 2 years, 67% (95 CI {54–84}) at 5 years and 60% (95 CI {43–82}) at 10 years ( Fig. 1 ). A lower age at implantation, a smaller diameter, and the occurrence of infective endocarditis was significantly associated with the revision surgery. Only 5 patients had infectious endocarditis over this period. Endocarditis-free survival was 94% (95 CI {88–100}) at 2 years, 92% (95 CI {84–100}) at 5 years and 92% (95 CI {84–100}) at 10 years. Our study suggests that Contegra® valve could constitute an attractive substitute for right ventricular outflow tract reconstruction. A multicenter study comparing long-term evolution of the whole valves currently available for pulmonary valvulation could confirm our results.