Prótesis pulmonar porcina versus yugular bovina para reparar el tracto de salida del ventrículo derecho en menores con cardiopatía congénita

Abstract

IntroductionIn some patients, in childhood, it may be necessary to recover the valve function of the right ventricular outflow tract, a sequel of the primary repair of their congenital heart disease. ObjectiveTo compare the outcomes of bovine jugular (YB) -Contegra® versus porcine prosthesis (PPP), implanted in patients under 18 years old. MethodsThe study included all patients under 18 years old and re-operated on between January 2003 and June 2015 after primary surgery right ventricle outflow tract, and in whom a YB/PPP was implanted. Prosthetic valve dysfunction criteria were, surgical/percutaneous re-intervention, and a gradient>50mmHg or severe prosthetic regurgitation. Statistical analysis was performed using SPSS 20.0. ResultsThere were 21 PPP implanted in 20 patients, and 15 YB in 15 patients. The study included 60% males. The most common primary congenital heart disease was Fallot. The groups were not exactly homogeneous. Of the 24 preoperative variables, 11 of them showed statistically significant differences (P<.05). These included a higher percentage of transannular surgery, indication of pulmonary regurgitation surgery, ventricular dilation, and dysfunction in the PPP group.Of the 15 perioperative variables, there were significant differences in, the mean age at implantation: 8.8±4.4 years YB versus 11.8±4 PPP (P=.044); valve diameter (P<.001) lower in YB. Need of aortic cross clamping (P=.015) however, higher in YB.There was no in-hospital or late mortality. Follow-up: 4.8 years YB versus 2.4 PPP (P=.046). Other postoperative variables with significant differences: transprosthetic gradient, residual prosthetic regurgitation, prosthetic dysfunction, all higher in YB group. ConclusionsWith prudence imposed by differences in follow-up time and type of previous surgery in both cohorts, it seems reasonable to choose a PPP to recover functionality of the right ventricle outflow tract.The YB could be used when a conduit is essential.