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Contegra versus pulmonary homograft for right ventricular outflow tract reconstruction in newborns

Published online by Cambridge University Press:  03 April 2019

Alessandro Falchetti ,
Hélène Demanet ,
Hugues Dessy ,
Christian Melot ,
Charalampos Pierrakos  and
Pierre Wauthy
Alessandro Falchetti
Affiliation:
Department of Cardiac Surgery, Hôpital Universitaire des Enfants Reine Fabiola (HUDERF), Université Libre de Bruxelles, Brussels, Belgium
Hélène Demanet
Affiliation:
Department of Cardiac Surgery, Hôpital Universitaire des Enfants Reine Fabiola (HUDERF), Université Libre de Bruxelles, Brussels, Belgium
Hugues Dessy
Affiliation:
Department of Cardiology, Hôpital Universitaire des Enfants Reine Fabiola (HUDERF), Université Libre de Bruxelles, Brussels, Belgium
Christian Melot
Affiliation:
Department of Emergency, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
Charalampos Pierrakos
Affiliation:
Department of Intensive Care, Centre Hospitalier Universitaire Brugmann, Université Libre de Bruxelles, Brussels, Belgium
Pierre Wauthy*
Affiliation:
Department of Cardiac Surgery, Hôpital Universitaire des Enfants Reine Fabiola (HUDERF), Université Libre de Bruxelles, Brussels, Belgium
*
Author for correspondence: Pierre Wauthy, MD, PhD, Service de Chirurgie Cardiaque, Hôpital Universitaire des Enfants Reine Fabiola (HUDERF), Avenue Jean Joseph Crocq 15, 1020 Brussels, Belgium. Tel: +32 (0)2 477 39 95; Fax: +32 (0)2 477.21.61; E-mail: pierre.wauthy@huderf.be
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Abstract

Objectives:

Pulmonary homografts are standard alternatives to right ventricular outflow tract reconstruction in congenital heart surgery. Unfortunately, shortage and conduit failure by early calcifications and shrinking are observed for small-sized homografts in younger patients. In neonates, Contegra® 12 mm (Medtronic Inc., Minneapolis, Minnesota, United States of America) could be a valuable alternative, but conflicting evidence exists. There is no published study considering only newborns with heterogeneous pathologies. We retrospectively compared the outcomes of these two conduits in this challenging population.

Methods:

Patients who underwent a right ventricular outflow tract reconstruction between January 1992 and December 2014 at the Hôpital Universitaire des Enfants Reine Fabiola were included. We retrospectively collected and analysed demographic, echocardiographic, surgical, and follow-up data.

Results:

Of the 53 newborns who benefited from a right ventricular outflow tract reconstruction during the considered period, 30 received a Contegra 12 mm (mean age 15 ± 8 days), and 23 a small (9–14 mm) pulmonary homograft (mean age 10 ± 7 days). Overall mortality was 16.6% with Contegra versus 17.4% in the pulmonary homograft group (p = 0.98 log-rank). Operative morbidity and early re-operation for conduit failure were not significantly different between the two groups. Mean follow-up in this study is 121 ± 74 months. Survival free from re-operation was not different between the two groups (p = 0.15). Multivariable analysis showed that weight and significant early gradient were factors associated with anticipated conduit failure.

Conclusions:

Contegra 12 mm is a valid alternative to small pulmonary homografts in a newborn patient population. Trial registration: NCT03348397.

Keywords

Contegracongenital heart diseasehomograftpulmonary valveright ventricular outflow tract reconstructionnewborn
Type
Original Article
Information
Cardiology in the Young , Volume 29 , Issue 4 , April 2019 , pp. 505 - 510
Copyright
© Cambridge University Press 2019 

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