Bovine jugular vein as right ventricle-to-pulmonary artery valved conduit

The reduced availability of homografts and investigations into the ideal valved conduit have prompted a search for alternative options. This prospective study evaluated the Contegra, a new biological valved conduit consisting of a glutaraldehyde-preserved heterologous bovine jugular vein having a trileaflet venous valve.

Between April 1999 and May 2001, 26 patients (mean age 13.5+/-12.5 years; range: 4 months to 43 years), of mean body weight 33.9+/-26.7 kg (range: 4.0-91.0 kg), underwent implantation of a Contegra valved conduit for the following diagnoses: pulmonary valve replacement during Ross operation (n = 11), pulmonary atresia with ventricular septal defect (n = 6), tetralogy of Fallot (n = 3), truncus arteriosus (n = 3), Taussig-Bing syndrome (n = 2), and pulmonary valve regurgitation (n = 1). Conduit size was 14 mm in two patients, 16 mm in four, 18 mm in three, 20 mm in three, and 22 mm in 14. Mean cardiopulmonary bypass time was 156+/-33 min (range: 105-233 min), and mean aortic cross-clamp time 79+/-29 min (range: 0-128 min).

There were no hospital deaths. During a mean follow up of 14.7+/-6.9 months (range: 1-26 months) there was one late death (4% mortality) that was unrelated to the valved conduit. Three children underwent reoperation; in all cases this was nonconduit-related. All 25 late survivors are currently free from reoperation and complications due to presence of the conduit. Echocardiographically monitored valve regurgitation was absent in 12 cases, trivial in nine and mild in four. The discharge situation was maintained during systematic follow up. No difference was found between the pressure gradient at discharge and at the last follow up.

The new conduit provided consistently good results during its first two years of use. The main advantages were: (i) excellent off-the-shelf availability; (ii) large variety of available sizes (12 to 22 mm internal diameter); (iii) easy tailoring and suturing; (iv) adequate hemodynamics; (v) no need for proximal or distal extension; and (vi) reduced cost (half that of a conventional homograft).