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Eur J Cardiothorac Surg 2007;32:209-214. doi:10.1016/j.ejcts.2007.04.036
Copyright © 2007, European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved

Compared fate of small-diameter Contegras^® and homografts in the pulmonary position

^a Department of Pediatric Thoracic and Cardiovascular Surgery, Congenital Cardiac Center (‘Deutsches Kinderherzzentrum’), Sankt Augustin, Germany
^b Department of Pediatric Cardiology, Congenital Cardiac Center (‘Deutsches Kinderherzzentrum’), Sankt Augustin, Germany
^c Department of Cardiac Intensive Care, Congenital Cardiac Center (‘Deutsches Kinderherzzentrum’), Sankt Augustin, Germany
^d Department of Anesthesiology and Critical Care Medicine, Congenital Cardiac Center (‘Deutsches Kinderherzzentrum’), Sankt Augustin, Germany

Received 16 February 2007; received in revised form 25 April 2007; accepted 30 April 2007.

^_* Corresponding author. Address: Deutsches Kinderherzzentrum, Asklepios Klinik, Arnold-Janssen-Strasse, 29 53757 Sankt Augustin, Germany. Tel.: +49 2241 249601; fax: +49 2241 249602. (Email: n.sinzobahamvya{at}asklepios.com).

Objective: This study analyzes whether small-diameter Contegras behave in the same way as small-diameter homografts, when implanted for the first time in pulmonary position. Methods: Small-diameter conduits include 12 and 14 mm Contegras and 8–14 mm homografts. Graft dysfunction is defined as right ventricular outflow tract obstruction with peak echo-Doppler gradient > 40 mmHg, or grade III/IV graft regurgitation. Graft failure is defined as need for conduit replacement or need for catheter or surgical reintervention. Thirty-eight patients who received small Contegras (n = 25) and small homografts (n = 13) from October 2002 to end December 2006 were studied. The most frequent indication was pulmonary atresia and ventricular septal defect (n = 20; 10 associated with major aorto-pulmonary collateral arteries), followed by truncus arteriosus (n = 12). Most patients’ characteristics were comparable except that recipients of homografts were smaller (p for body area = 0.014). Survival, freedom from graft dysfunction, failure and explantation were estimated by the Kaplan–Meier method. The log-rank test was used to compare outcomes. Results: There were three early and four late deaths. No death was graft related. Survival was 80 ± 8.2% for patients with Contegras and 77 ± 11.7% for those with allografts: p = 0.82. Mean follow-up duration is 22 ± 16 months. Freedom from dysfunction for Contegra conduits decreased in the first 6 months and stabilized at 58 ± 11% from month 14. For homografts it decreased only 1 year after implantation, down to 35 ± 19.7% from month 31: p = 0.61. Freedom from Contegra failure diminished the first 16 months to level out at 57 ± 13%. No homograft failed the first 2 years. With a p-value of 0.14, homografts tended to fail less frequently. Five grafts were explanted. Freedom from explantation was similar (p = 0.98): 90 ± 6.7% for Contegras and 75 ± 21.6% for homografts at year 3. Conclusion: In the first 4 years after pulmonary implantation of small-diameter Contegras and homografts, the fate of both conduits was statistically similar, in spite of different behavior. As Contegra is ‘off-the-shelf’ available, it constitutes a sound alternative to homograft for right ventricular outflow tract reconstruction in neonates and infants.

Key Words: Valved conduits • Contegra • Homograft • Right ventricular outflow tract reconstruction

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