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Eur J Cardiothorac Surg 2006;29:397-405
© 2006 Elsevier Science NL

Right ventricular outflow tract reconstruction using Contegra^® valved conduit: natural history and conduit performance under pressure

^a Paediatric Cardiac Unit, Paediatric Cardiology and Cardiac Surgery Department, Birmingham Children's Hospital, B4 6LT Birmingham, UK
^b Paediatric Cardiology Department, Glenfield hospital, Leicester, UK

Received 5 August 2005; received in revised form 14 November 2005; accepted 15 November 2005.

^_* Corresponding author. Tel.: +44 121 3339437; fax: +44 121 3339441. (Email: david.barron{at}bch.nhs.uk).

Objective: To assess the performance of the bovine Contegra^® valved conduit used for right ventricular (RV) outflow tract reconstruction, particularly in relation to post-operative RV pressure. Methods: Follow-up study of 64 consecutive right ventricular to pulmonary artery-conduit implants in 62 patients between January 2000 and April 2003. The majority of cases were forms of pulmonary atresia/VSD (n = 24, 39%) or Fallot's tetralogy (n = 13, 21%). Thirteen cases (21%) had aortic atresia, truncus arteriosus or discordant connections with pulmonary atresia/VSD. Twelve cases (19%) were conduit replacements. Echocardiography was performed for a median follow-up of 14 months (range 0–38 months). Results: Median age at implantation was 13.8 months (range 0.1–244 months) and median weight was 8.9 kg (range 2.1–84.1 kg). Thirty-eight patients (59.4%) were <10 kg at the time of surgery. Early mortality was 6.4% (n = 4). During follow-up there were four explantations (one for endocarditis and three for conduit dilatation) and 16 (28.6%) catheter interventions. Overall freedom from intervention at 1 and 3 years was 71 ± 6% and 53 ± 11%, respectively. Freedom from conduit-specific reintervention was 66 ± 11% at the end of the study period. Reintervention was associated with small conduits (p = 0.04), age <1 year (p = 0.04) and with high RV/LV pressure ratio in the immediate post-operative period (p = 0.0003). On multivariate analysis, the RV/LV pressure ratio was the strongest single factor predicting the overall reintervention (OR 5.45). Acquired distal conduit stenosis at suture line was the commonest indication for conduit-specific reintervention and was associated with the smaller conduits. The conduits explanted for dilatation showed neointimal proliferation, thrombosis, calcification and chronic inflammation. Conclusions: The Contegra conduit is widely applicable to RVOT reconstruction with satisfactory mid-term results. However, there is a significant incidence of conduit-related complications, particularly with the smaller conduits. Adverse performance was strongly associated with high RV/LV pressure ratio at completion of surgery. We would recommend cautious use of the conduits in patients with predicted high RV/LV pressure ratios, where careful monitoring of conduit performance is crucial. There is some element of unpredictability, which adds to the importance of close follow-up. Further studies are needed to explore the issues of thrombogenicity, degeneration, possible ‘rejection’, and the potential role of anti-platelet and anti-inflammatory modulation.

Key Words: Bovine Contegra^® valved conduit • Right ventricular outflow tract reconstruction • Right ventricular to left ventricular pressure ratio

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