Hostname: page-component-78c5997874-4rdpn Total loading time: 0 Render date: 2024-11-10T13:10:07.677Z Has data issue: false hasContentIssue false
  • English
  • Français

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
Get access Rights & Permissions [Opens in a new window]

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 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Ross, DN. Replacement of aortic and mitral valves with a pulmonary autograft. Lancet 1967; 2: 956–958.10.1016/S0140-6736(67)90794-5CrossRefGoogle ScholarPubMed
Ross, DN, Somerville, J. Correction of pulmonary atresia with a homograft aortic valve. Lancet 1966; 2: 1446–1447.10.1016/S0140-6736(66)90600-3CrossRefGoogle ScholarPubMed
Bando, K, Danielson, GK, Schaff, HV, Mair, DD, Julsrud, PR, Puga, FJ. Outcome of pulmonary and aortic homografts for right ventricular outflow tract reconstruction. J Thorac Cardiovasc Surg 1995; 109: 509–517.10.1016/S0022-5223(95)70282-2CrossRefGoogle ScholarPubMed
Tweddell, JS, Pelech, AN, Frommelt, PC, et al. Factors affecting longevity of homograft valves used in right ventricular outflow tract reconstruction for congenital heart disease. Circulation 2000; 102 (19 Suppl 3): III130–135.10.1161/01.CIR.102.suppl_3.III-130CrossRefGoogle ScholarPubMed
Wells, WJ, Arroyo, H Jr, Bremner, RM, Wood, J, Starnes, VA. Homograft conduit failure in infants is not due to somatic outgrowth. J Thorac Cardiovasc Surg 2002; 124: 88–96.10.1067/mtc.2002.121158CrossRefGoogle Scholar
Bové, T, Demanet, H, Wauthy, P, et al. Early results of valved bovin jugular vein conduit versus bicuspid homograft for right ventricular outflow tract reconstruction. Ann Thorac Surg 2002; 74: 536–541.CrossRefGoogle Scholar
Corno, AF, Qanadli, SD, Sekarski, N, et al. Bovine valved xenograft in pulmonary position: medium-term follow-up with excellent hemodynamics and freedom from calcification. Ann Thorac Surg 2004; 78: 1382–1388.10.1016/j.athoracsur.2004.02.095CrossRefGoogle ScholarPubMed
Brown, JW, Ruzmetov, M, Rodefeld, MD, Vijay, P, Darragh, RK. Valved bovine jugular vein conduits for right ventricular outflow tract reconstruction in children: an attractive alternative to pulmonary homograft. Ann Thorac Surg 2006; 82: 909–916.10.1016/j.athoracsur.2006.03.008CrossRefGoogle ScholarPubMed
Bautista-Hernandez, V1, Kaza, AK, Benavidez, OJ, Pigula, FA. True aneurysmal dilatation of a Contegra conduit after right ventricular outflow tract reconstruction: a novel mechanism of conduit failure. Ann Thorac Surg 2008; 86: 1976–1977.10.1016/j.athoracsur.2008.04.104CrossRefGoogle ScholarPubMed
Boudjemline, Y, Bonnet, D, Agnoletti, G, Vouhé, P. Aneurysm of the right ventricular outflow following bovine valved venous conduit insertion. Eur J Cardiothorac Surg 2003; 23: 122–124.10.1016/S1010-7940(02)00660-7CrossRefGoogle ScholarPubMed
Meyns, B, Van Garsse, L, Boshoff, D, et al. The Contegra conduit in the right ventricular outflow tract induces supravalvular stenosis. J Thorac Cardiovasc Surg 2004; 128: 834–840.10.1016/j.jtcvs.2004.08.015CrossRefGoogle ScholarPubMed
Gist, KM, Mitchell, MB, Jaggers, J, Campbell, DN, Yu, JA, Landeck II, BF. Assessment of the relationship between Contegra conduit size and early valvar insufficiency. Ann Thorac Surg 2012; 93: 856–861.CrossRefGoogle ScholarPubMed
Tiete, AR, Sachweh, JS, Roemer, U, Kozlik-Feldmann, R, Reichart, B, Daebritz, SH. Right ventricular outflow tract reconstruction with the Contegra bovine jugular vein conduit: a word of caution. Ann Thorac Surg 2004; 77: 2151–2156.10.1016/j.athoracsur.2003.12.068CrossRefGoogle ScholarPubMed
Zilberman, MV, Khoury, PR, Kimball, RT. Two-dimensional echocardiographic valve measurements in healthy children: gender-specific differences. Pediatr Cardiol 2005; 26: 356–360.CrossRefGoogle ScholarPubMed
Fiore, AC, Ruzmetov, M, Huynh, D, et al. Comparison of bovine jugular vein with pulmonary homograft conduits in children less than 2 years of age. Eur J Cardiothorac Surg 2010; 38: 318–325.10.1016/j.ejcts.2010.01.063CrossRefGoogle ScholarPubMed
Sierra, J, Christenson, JT, Lahlaidi, NH, Beghetti, M, Kalangos, A. Right ventricular outflow tract reconstruction: what conduit to use? Homograft or Contegra? Ann Thorac Surg 2007; 84: 606–610.CrossRefGoogle ScholarPubMed
Shaddy, RE, Hunter, DD, Osborn, RA, et al. Prospective analysis of HLA immunogenicity of cryopreserved valved allografts used in pediatric heart surgery. Circulation 1996; 94: 1063–1067.CrossRefGoogle ScholarPubMed
Hawkins, JA, Breinhold, JP, Lambert, LM, et al. Class I and class II anti HLA antibodies after implantation of cryopreserved allograft material in pediatric patients. J Thorac Cardiovasc Surg 2000; 119: 324–330.10.1016/S0022-5223(00)70188-7CrossRefGoogle Scholar
Hoekstra, F, Knoop, C, Vaessen, L, et al. Donor specific cellular immune response against human cardiac valve allografts. J Thorac Cardiovasc Surg 1996; 112: 281–286.CrossRefGoogle ScholarPubMed
Hoekstra, F, Wityliet, M, Knoop, C, et al. Donor specific anti-human leukocyte antigen class I antibodies after implantation of cardiac valve allografts. J Heart Lung Transplant 1997; 16: 570–572.Google Scholar
Baskett, RJ, Nanton, MA, Warren, AE, Ross, DB. Human leukocyte antigen-DR and ABO mismatch are associated with accelerated homograft valve failure in children: implications for therapeutic interventions. J Thorac Cardiovasc Surg 2003; 126: 232–239.CrossRefGoogle ScholarPubMed
Christenson, JT, Sierra, J, Colina Manzano, NE, Jolou, J, Beghetti, M, Kalangos, A. Homografts and xenografts for right ventricular outflow tract reconstruction: long-term results. Ann Thorac Surg 2010; 90: 1287–1293.10.1016/j.athoracsur.2010.06.078CrossRefGoogle ScholarPubMed
Fiore, AC, Brown, JW, Turrentine, MW, et al. A bovine jugular vein conduit: a ten-year bi-institutional experience. Ann Thorac Surg 2011; 92: 183–190.10.1016/j.athoracsur.2011.02.073CrossRefGoogle ScholarPubMed
Boethig, D, Thies, WR, Hecker, H, Breymann, T. Midterm course after pediatric right ventricular outflow tract reconstruction: a comparison of homografts, porcine xenografts and Contegra. Eur J Cardiothorac Surg 2005; 27: 58–66.10.1016/j.ejcts.2004.09.009CrossRefGoogle Scholar
Goh, ET, Wong, E, Farhatnia, Y, Tan, A, Seifalian, AM. Accelerating in situ endothelialization of cardiovascular bypass grafts. Int J Mol Sci 2014; 16: 597–627.CrossRefGoogle Scholar
Rastan, AJ, Walther, T, Daehnert, I, et al. Bovine jugular vein conduit for right ventricular outflow tract reconstruction: evaluation of risk factors for mid-term outcome. Ann Thorac Surg 2006; 82: 1308–1315.CrossRefGoogle ScholarPubMed
Breymann, T, Blanz, U, Wojtalik, MA, et al. European Contegra multicentre study: 7-year results after 165 valved bovine jugular vein graft implantations. Thorac Cardiovasc Surg 2009; 57: 257–269.10.1055/s-0029-1185513CrossRefGoogle ScholarPubMed
Sinzobahamvya, N, Asfour, B, Boscheinen, M, et al. Compared fate of small-diameter Contegras and homografts in the pulmonary position. Eur J Cardiothorac Surg 2007; 32: 209–214.10.1016/j.ejcts.2007.04.036CrossRefGoogle ScholarPubMed
Boethig, D, Goerler, H, Westhoff-Bleck, M, et al. Evaluation of 188 consecutive homografts implanted in pulmonary position after 20 years. Eur J Cardiothorac Surg 2007; 32: 133–142.CrossRefGoogle ScholarPubMed
Hickey, EJ, McCrindle, BW, Blackstone, EH, et al. Jugular venous valved conduit (Contegra) matches allograft performance in infant truncus arteriosus repair. Eur J Cardiothorac Surg 2008; 33: 890–898.CrossRefGoogle ScholarPubMed
Sinzobahamvya, N, Boscheinen, M, Blaschczok, HC, et al. Survival and reintervention after neonatal repair of truncus arteriosus with valved conduit. Eur J Cardiothorac Surg 2008; 34: 732–737.10.1016/j.ejcts.2008.06.021CrossRefGoogle ScholarPubMed
Ugaki, S, Rutledge, J, Al Aklabi, M, Ross, DB, Adatia, I, Rebekya, IM. 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 2015; 99: 140–146.10.1016/j.athoracsur.2014.08.034CrossRefGoogle ScholarPubMed
Mery, CM, Guzmán-Pruneda, FA, De León, LE, et al. Risk factors for development of endocarditis and reintervention in patients undergoing right ventricle to pulmonary artery valved conduit placement. J Thorac Cardiovasc Surg 2016; 151: 432–441.CrossRefGoogle ScholarPubMed
Bahaaldin, A. Right ventricle-to-pulmonary artery conduits: do we really have an option? J Thorac Cardiovasc Surg 2016; 151: 442–443.Google Scholar