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Eur J Cardiothorac Surg 2003;24:851
© 2003 Elsevier Science NL

Letter to the Editor

Reply to Boudjemline et al.

T. Ishizaka, R.G. Ohye*

Division of Pediatric Cardiovascular Surgery, Section of Cardiac Surgery, The University of Michigan Health System, Ann Arbor, MI, USA

Received 6 August 2003; accepted 9 August 2003.

* Corresponding author. F 7830 C.S. Mott Children's Hospital, 1500E Medical Center Drive, Ann Arbor, MI 48109, USA. Tel.: +1-734-936-4978; fax: +1-734-763-7353
e-mail: ohye{at}med.umich.edu

Key Words: Pulmonary valved conduit • Contegra® bovine jugular vein graft • Shelhigh No-React® porcine pulmonary valve conduit • Right ventricular outflow tract reconstruction

We appreciate the comments of Boudjemline et al. regarding their observations of similar clinical results with the ContegraTM bovine jugular vein graft and the Shelhigh No-ReactTM porcine pulmonary valve conduit. They postulate a similar host immune response to the xenograft tissues, leading to the clinical development of a pseudointimal peel. In general terms, we would agree that it seems likely that the host immune response plays an important role. However, on a cellular and molecular level, it is possible that subtle or great differences in the immune mechanism may lead to the common final outcome of a thick pseudointima in these two xenografts. It is important to note that even non-biological Dacron develops a peel, which can histologically appear similar, albeit less frequently clinically problematic.

Interestingly, we did not observe a similar occurrence of aneurysm formation in our Shelhigh No-ReactTM conduits. The one aneurysm seen in our series was a pseudoaneurysm at the suture line. We have also not had a similar problem of distal anastomotic stenosis, or aneurysm formation in our experience with the ContegraTM graft. It is difficult to comment on the differences between our two series without being able to compare the patient populations, surgical technique and long-term management.





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