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Jugular venous valved conduit (Contegra^®) matches allograft performance in infant truncus arteriosus repair

^a The Congenital Heart Surgeons’ Society Data Center, Toronto, Canada
^b The Hospital for Sick Children, Toronto, Ontario, Canada
^c Cleveland Clinic Foundation, Cleveland, OH, United States
^d Tulane University, New Orleans, LA, United States
^e Boston Children's Hospital, Boston, MA, United States
^f Children's Hospital, Denver, CO, United States
^g Montreal Children's Hospital, Montreal, Quebec, Canada
^h Primary Childrens Medical Center, 100 North Medical Drive, Salt Lake City, UT 84113, United States

Received 28 August 2007; received in revised form 7 December 2007; accepted 19 December 2007.

^_* Corresponding author. Tel.: +1 801 588 3345; fax: +1 801 588 3343. (Email: john.hawkins{at}hsc.utah.edu).

Objective: Limited availability and durability of allograft conduits require that alternatives be considered. We compared bovine jugular venous valved (JVV) and allograft conduit performance in 107 infants who survived truncus arteriosus repair. Methods: Children were prospectively recruited between 2003 and 2007 from 17 institutions. The median z-score for JVV (n = 27, all 12 mm) was +2.1 (range +1.2 to +3.2) and allograft (n = 80, 9–15 mm) was +1.7 (range –0.4 to +3.6). Propensity-adjusted comparison of conduit survival was undertaken using parametric risk-hazard analysis and competing risks techniques. All available echocardiograms (n = 745) were used to model deterioration of conduit function in regression equations adjusted for repeated measures. Results: Overall conduit survival was 64 ± 9% at 3 years. Conduit replacement was for conduit stenosis (n = 16) and/or pulmonary artery stenosis (n = 18) or regurgitation (n = 1). The propensity-adjusted 3-year freedom from replacement for in-conduit stenosis was 96 ± 4% for JVV and 69 ± 8% for allograft (p = 0.05). The risk of intervention or replacement for branch pulmonary artery stenosis was similar for JVV and allograft. Smaller conduit z-score predicted poor conduit performance (p < 0.01) with best outcome between +1 and +3. Although JVV conduits were a uniform diameter, their z-score more consistently matched this ideal. JVV exhibited a non-significant trend towards slower progression of conduit regurgitation and peak right ventricular outflow tract (RVOT) gradient. In addition, catheter intervention was more successful at slowing subsequent gradient progression in children with JVV versus those with allograft (p < 0.01). Conclusions: JVV does match allograft performance and may be advantageous. It is an appropriate first choice for repair of truncus arteriosus, and perhaps other small infants requiring RVOT reconstruction.

Key Words: Truncus arteriosus • Allograft • Contegra^® • Conduit

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