Bovine jugular vein conduit versus pulmonary homograft in the Ross operation

Abstract

Objectives:The Ross procedure involves using the native pulmonary valve for aortic valve replacement then replacing the pulmonary valve with an allograft or xenograft. We aimed to compare our age-matched experience with the bovine jugular vein conduit and the pulmonary homograft for pulmonary valve replacement during the Ross procedure in children.Methods:Between 1998 and 2016, 15 patients <18 years of age underwent a Ross procedure using the bovine jugular vein conduit (Ross-Bovine Jugular Vein Conduit) at our institution. These patients were age-matched with 15 patients who had the Ross operation with a standard pulmonary homograft for right ventricular outflow tract reconstruction (Ross-Pulmonary Homograft). Paper and electronic medical records were retrospectively reviewed.Results:The median age of the Ross-Bovine Jugular Vein Conduit and Ross-Pulmonary Homograft patients were 4.8 years (interquartile range 1.1–6.6) and 3.3 years (interquartile 1.2–7.6), respectively (p = 0.6). The median follow-up time for the Ross-Bovine Jugular Vein Conduit and Ross-Pulmonary Homograft groups were 1.7 years (interquartile range 0.5–4.9) and 6.8 years (interquartile range 1.9–13.4), respectively (p = 0.03). Overall, 5-year survival, freedom from redo aortic valve replacement, and freedom from pulmonary valve replacement were similar between groups.Conclusion:The bovine jugular vein conduit and pulmonary homograft have favourable mid-term durability when used for right ventricular outflow tract reconstruction for the Ross operation. The bovine jugular vein conduit may be a suitable replacement for appropriately sized patients undergoing a Ross aortic valve replacement, though longer follow-up is needed.

Conduits for Right Ventricular Outflow Tract Reconstruction in Infants and Young Children

“…There is no doubt that the bovine jugular vein conduit (BJVC), usually known as Contegra R conduit (Medtronic Inc., Minneapolis, Minnesota, USA), has achieved great success. It showed comparable (11,12) or even better (13)(14)(15) performance than homograft. Still, the durability of BJVC is very poor in infants (16).…”

Application of Homograft Valved Conduit in Cardiac Surgery

“…At long-term follow-up, the homograft conduits functioned satisfactorily in the pulmonary artery location. Clinical study data from Parth et al ( 43 ) showed good mid-term durability of the homograft pulmonary valved conduits when used for right ventricular outflow tract reconstruction for the Ross procedure. At present, the main clinical application is pulmonary valved conduit, while aortic valved conduit is less.…”

“…Some studies have shown that BJV conduits have good medium-term durability, but have not been compared with the homograft or other types of conduits ( 88 , 89 ). Therefore, this conduit will require further observation at longer follow-up times to clarify the differences in performance compared to equivalent sized cryopreserved homograft ( 43 ). Alessandro et al ( 90 ) suggests that the 12 mm ConIntegra is an effective alternative to small homogaft valved conduit in the neonatal patient population.…”

Bovine jugular vein conduit: What affects its elastomechanical properties and thermostability?

“…The long-term results obtained with Contegra are the same as those obtained from allograft in clinical studies. 9,10 However, most researchers agree that when using Contegra, the risk of distal stenosis and infective endocarditis is significantly higher. 6,[11][12][13] As with other xenogeneic bioprostheses, there is a significant risk of calcification with Contegra.…”