Advertisement

Pediatric Cardiology

, Volume 40, Issue 4, pp 848–856 | Cite as

Outcomes of Prosthetic Valved Conduits for Right Ventricular Outflow Tract Reconstruction

  • Hao Chen
  • Guocheng Shi
  • Lisheng Qiu
  • Shunmin Wang
  • Huiwen Chen
  • Zhiwei XuEmail author
Original Article

Abstract

There are limited data regarding the implantation of prosthetic valved conduits for right outflow tract reconstruction in pediatric patients in China. A retrospective review of 128 patients undergoing conduits implantation with a median follow-up of 33.3 months (range, 3.3 months to 10.1 years) was performed between 2009 and 2018. Multivariate Cox regression model was used to analyze the risk factors for mortality, reintervention and endocarditis. Freedom from reintervention and endocarditis were plotted using the Kaplan–Meier curve. Hospital mortality was 7.8%, and the late mortality was 3.1%. Patient survival at 1, 5 and 10 years was 92.2%, 87.1% and 84.3%, respectively. Freedom from reintervention at 1 and 5 years was 94.1% and 60.9%. Small size conduit (p = 0.019) and previous palliation (p < 0.001) were predictive of reintervention. Ten conduits developed endocarditis at a median of 4.8 years after implantation. Freedom from endocarditis at 1, 5 and 10 years was 99.1%, 93.0% and 58.0%, respectively. Diffuse stenosis of the conduit (p = 0.003) was an independent risk factor for late endocarditis. Both bovine jugular venous conduits and bovine pericardial prosthetic conduits are associated with acceptable outcomes. Reintervention remains high in patients who have smaller size conduit and undergo previous palliation. It is plausible that the suboptimal flow may be one of major mechanisms involved in the development of late endocarditis.

Keywords

Congenital heart disease Right ventricular outflow tract reconstruction Prosthetic valved conduits Endocarditis Risk factors 

Notes

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Research Involving Human and Animal Participants

This article does not contain any studies with human participants performed by any of the authors.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

246_2019_2081_MOESM1_ESM.docx (17 kb)
Supplementary material 1 (DOCX 16 KB)

References

  1. 1.
    Boethig D, Thies WR, Hecker H, Breymann T (2005) Mid-term course after pediatric right ventricular outflow tract reconstruction: a comparison of homografts, porcine xenografts and Contegras. Eur J Cardiothorac Surg 27(1):58–66CrossRefGoogle Scholar
  2. 2.
    Hickey EJ, McCrindle BW, Blackstone EH, Yeh T Jr, Pigula F, Clarke D et al (2008) Jugular venous valved conduit (Contegra) matches allograft performance in infant truncus arteriosus repair. Eur J Cardiothorac Surg 33(5):890–898CrossRefGoogle Scholar
  3. 3.
    Christenson JT, Sierra J, Colina Manzano NE, Jolou J, Beghetti M, Kalangos A (2010) Homografts and xenografts for right ventricular outflow tract reconstruction: long-term results. Ann Thorac Surg 90(4):1287–1293CrossRefGoogle Scholar
  4. 4.
    Prior N, Alphonso N, Arnold P, Peart I, Thorburn K, Venugopal P et al (2011) Bovine jugular vein valved conduit: up to 10 years follow-up. J Thorac Cardiovasc Surg 141(4):983–987CrossRefGoogle Scholar
  5. 5.
    Shinkawa T, Tang X, Gossett JM, Mustafa T, Hategekimana F, Watanabe F et al (2015) Valved polytetrafluoroethylene conduits for right ventricular outflow tract reconstruction. Ann Thorac Surg 100(1):129–137CrossRefGoogle Scholar
  6. 6.
    Ootaki Y, Welch AS, Walsh MJ, Quartermain MD, Williams DA, Ungerleider RM (2018) Medium-term outcomes after implantation of expanded polytetrafluoroethylene valved conduit. Ann Thorac Surg 105(3):843–850CrossRefGoogle Scholar
  7. 7.
    Albanesi F, Sekarski N, Lambrou D, Von Segesser LK, Berdajs DA (2014) Incidence and risk factors for Contegra graft infection following right ventricular outflow tract reconstruction: long-term results. Eur J Cardiothorac Surg 45(6):1070–1074CrossRefGoogle Scholar
  8. 8.
    Ugaki S, Rutledge J, Al Aklabi M, Ross DB, Adatia I, Rebeyka IM (2015) An increased incidence of conduit endocarditis in patients receiving bovine jugular vein grafts compared to cryopreserved homograft for right ventricular outflow reconstruction. Ann Thorac Surg 99(1):140–146CrossRefGoogle Scholar
  9. 9.
    Mery CM, Guzmán-Pruneda FA, De León LE, Zhang W, Terwelp MD, Bocchini CE et al (2016) Risk factors for development of endocarditis and reintervention in patients undergoing right ventricle to pulmonary artery valved conduit placement. J Thorac Cardiovasc Surg 151(2):432–439CrossRefGoogle Scholar
  10. 10.
    Boethig D, Schreiber C, Hazekamp M, Blanz U, Prêtre R, Asfour B et al (2012) Risk factors for distal Contegra stenosis: results of a prospective European multicentre study. Thorac Cardiovasc Surg 60(3):195–204CrossRefGoogle Scholar
  11. 11.
    Shebani SO, McGuirk S, Baghai M, Stickley J, De Giovanni JV, Bu’lock FA et al (2006) Right ventricular outflow tract reconstruction using Contegra valved conduit: natural history and conduit performance under pressure. Eur J Cardiothorac Surg 29(3):397–405CrossRefGoogle Scholar
  12. 12.
    Urso S, Rega F, Meuris B, Gewillig M, Eyskens B, Daenen W et al (2011) The Contegra conduit in the right ventricular outflow tract is an independent risk factor for graft replacement. Eur J Cardiothorac Surg 40(3):603–609Google Scholar
  13. 13.
    Wojtalik M, Mrowczynski W, Zeromski J, Bartkowski R (2003) Does contegra xenograft implantation evoke cellular immunity in children? Interact Cardiovasc Thorac Surg 2(3):273–278CrossRefGoogle Scholar
  14. 14.
    Berdajs DA, Mosbahi S, Charbonnier D, Hullin R, von Segesser LK (2015) Analysis of flow dynamics in right ventricular outflow tract. J Surg Res 197(1):50–57CrossRefGoogle Scholar
  15. 15.
    Meyns B, Van Garsse L, Boshoff D, Eyskens B, Mertens L, Gewillig M et al (2004) The Contegra conduit in the right ventricular outflow tract induces supravalvular stenosis. J Thorac Cardiovasc Surg 128(6):834–840CrossRefGoogle Scholar
  16. 16.
    Zhang HF, Chen G, Ye M, Yan XG, Tao QL, Jia B (2017) Mid- to long-term outcomes of bovine jugular vein conduit implantation in Chinese children. J Thorac Dis 9(5):1234–1239CrossRefGoogle Scholar
  17. 17.
    Beckerman Z, De León LE, Zea-Vera R, Mery CM, Fraser CD Jr (2018) High incidence of late infective endocarditis in bovine jugular vein valved conduits. J Thorac Cardiovasc Surg 156(2):728–734CrossRefGoogle Scholar
  18. 18.
    Tiete AR, Sachweh JS, Roemer U, Kozlik-Feldmann R, Reichart B, Daebritz SH (2004) Right ventricular outflow tract reconstruction with the Contegra bovine jugular vein conduit: a word of caution. Ann Thorac Surg 77(6):2151–2156CrossRefGoogle Scholar
  19. 19.
    Morales DLS, Braud BE, Gunter KS, Carberry KE, Arrington KA, Heinle JS et al (2006) Encouraging results for the Contegra conduit in the problematic right ventricle–to–pulmonary artery connection. J Thorac Cardiovasc Surg 132(3):665–671CrossRefGoogle Scholar
  20. 20.
    Baltimore RS, Gewitz M, Baddour LM, Beerman LB, Jackson MA, Lockhart PB et al (2015) Infective endocarditis in childhood: 2015 update: a scientific statement from the American Heart Association. Circulation 132(15):1487–1515CrossRefGoogle Scholar
  21. 21.
    Jalal Z, Galmiche L, Lebeaux D, Villemain O, Brugada G, Patel M et al (2015) Selective propensity of bovine jugular vein material to bacterial adhesions: an in-vitro study. Int J Cardiol 198:201–205CrossRefGoogle Scholar
  22. 22.
    Schoen FJ, Levy RJ (1984) Bioprosthetic heart valve failure: pathology and pathogenesis. Cardiol Clin 2(4):717–739CrossRefGoogle Scholar
  23. 23.
    Veloso TR, Claes J, Van Kerckhoven S, Ditkowski B, Hurtado-Aguilar LG, Jockenhoevel S et al (2018) Bacterial adherence to graft tissues in static and flow conditions. J Thorac Cardiovasc Surg 155(1):325–332CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Cardio-thoracic Surgery, Heart Center, Shanghai Children’s Medical Center, School of MedicineShanghai Jiao Tong UniversityShanghaiChina

Personalised recommendations