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Eur J Cardiothorac Surg 2005;27:58-66
© 2005 Elsevier Science NL

Mid term course after pediatric right ventricular outflow tract reconstruction: a comparison of homografts, porcine xenografts and Contegras

^a Department for Pediatric Cardiology and Intensive Care, Hannover Medical School, Carl-Neuberg-Str. 1, D-30625 Hannover, Germany
^b Pediatric Cardiology Practice, Karmarschstr. 36, D-30159 Hannover, Germany
^c Institute of Biometrics, Hannover Medical School, Carl-Neuberg-Str. 1, D-30625 Hannover, Germany
^d Department of Surgery for Congenital Heart Disease, Hannover Medical School, Carl-Neuberg-Str. 1, D-30625 Hannover, Germany

Received 9 February 2004; received in revised form 12 August 2004; accepted 1 September 2004.

^* Corresponding author. Tel.: +49 511 532 9828; fax: +49 511 532 9832. (E-mail: breymann{at}thg.mh-hannover.de).

Objective: Homografts and porcine xenografts are valved conduits for pediatric RVOT reconstruction. They lack availability and durability. The Contegra, a glutaraldehyde fixed bovine jugular vein, was developed as an alternative. In this article, we compare single center results of 190 RVOT conduit implantations. Methods: 52 homografts, 30 porcine xenografts, 108 Contegras were implanted since 1992. Since 1999, data collection was prospective, for Contegras within a controlled clinical trial. Follow-up is complete for all evaluated items. We stratified reoperations by problem zone (sub-, intra-, and supravalvular) and analyzed the role of patient age, diagnosis, graft type, graft size, previous operations and year of operation on freedom from explantation or reoperation related to supravalvular reasons. Results: Porcine xenografts were inferior concerning freedom from explantation and reoperation (P<0.0001). They gave erlier reason for explantation in each zone (P<0.001). At 4 years, homograft valve related reoperation need reached 20%, Contegras 0% (P=0.002). Supravalvlar reoperation reasons developed about equally in homografts and Contegras. Multivariable Cox' regression analysis showed porcine xenografts and age <1 year as independent risk factors for explantation due to supravalvular reasons. We found no reason to assume that supravalvular reoperation reasons occured more frequently after Contegra than after homograft implantation. Conclusion: After 12 years RVOT reconstruction with 190 valved conduits, Contegras remain our device of choice. At 4 years, they show no subvalvular or valvular reason for explantation or reoperation. Contegras have the advantages of easy handling and availability, and they compare well with homografts regarding freedom from explantation and freedom from reoperation.

Key Words: Right ventricular outflow tract • Conduit durability • Congenital cardiac surgery • Contegra

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