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Letters to the Editor |
a Department of Cardiovascular surgery, Frontier Lifeline and Dr K.M. Cherian Heart Foundation, International Centre for Cardio Thoracic & Vascular Diseases, # R-30-C Ambattur Industrial Estate Road, Chennai 600101, India
b World Heart Foundation, Washington DC, USA
Received 17 July 2008; accepted 30 September 2008.
* Corresponding author. Tel.: +91 44 42017575; fax: +91 44 26565150. (Email: antos6{at}yahoo.com; drkmc{at}frontierlifeline.com).
Key Words: Decellularised conduits • Bovine jugular vein • Truncus arteriosus
We have reviewed the article ‘Jugular venous valved conduit (Contegra®) matches allograft performance in infant truncus arteriosus repair’ by Hickey et al. [1] published in the June 2008 issue of EJCTS with considerable interest. Traditionally, the allograft valve conduit is considered to be the ‘gold standard’ for RVOT reconstruction. This study suggests that the valved bovine jugular vein fares as well, if not better, than the allograft conduit, even for truncus arteriosus repair in infancy.
Facing the problem of non availability of homografts in the appropriate sizes, and the prohibitive high cost of the Contegra® graft, as well as for commercially available homograft conduits, we instituted the use of an indigenously developed decellularised valved bovine jugular vein conduit, processed in our own research facility to establish RV to PA continuity in the surgical repair of various congenital heart diseases (a total of 83 patients: decellularised porcine pulmonary artery in 43 and decellularised bovine jugular vein in 40), after ethical committee clearance for clinical application.
Between May 2004 and April 2008, 10 infants underwent surgical repair of truncus arteriosus employing indigenously processed valved bovine jugular vein conduit of sizes 11–16 mm (median 13 mm) for RVOT reconstruction. The mean age of these patients was 2.05 months (range 15 days to 7 months) and the mean weight was 3.6 kg (range 2.5–4.5 kg). The mean z-score of the decellularised BJV conduit was 3.33 (range 1.33–4.46). One patient died on the 4th postoperative day due to low cardiac output.
The patients have been followed up at varying periods from May 2004 to May 2008. Conduit replacement was required in one patient 6 months following surgery due to dilatation of the bovine jugular vein conduit with severe regurgitation. The problem of early dilatation of conduit has been managed by wrapping the conduit with a piece of decellularised bovine pericardium. We are also working on collagen coating of the conduit before implantation to provide strength and prevent dilatation.
The major advantages of decellularised bovine jugular vein conduits in our experience are:
Based on this early, limited experience with comparatively short follow-up, we believe that decellularised bovine jugular vein conduits are safe to use, have good handling characteristics, and have performed well in early follow-up. These conduits are especially relevant for the developing nations due to their easy availability in different sizes and lower cost, costing half as much as the commercially available conduits.
Footnotes
The authors of the original paper [1] were invited to reply to this Letter to the Editor but their reply was not received.
References
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