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Right ventricular outflow tract reconstruction with the bovine jugular vein graft: 5 years' experience with 133
Nicole Sekarski1, Hélène van Meir, Marry E B Rijlaarsdam
1Pediatric Cardiology Unit, Department of Cardiac Surgery, Centre Hospitalier Universitaire Vaudoise, Lausanne, Switzerland.
Insights
Bovine jugular vein grafts are effective for right ventricular outflow tract reconstruction in children. However, younger patients and small pulmonary arteries are associated with increased risk of distal conduit stenosis.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Biomaterials Science
Background:
- Utilized bovine jugular vein grafts for right ventricular outflow tract reconstruction in pediatric patients.
- Analyzed outcomes from two major medical centers.
Purpose of the Study:
- Evaluate the efficacy and long-term outcomes of bovine jugular vein grafts in pediatric right ventricular outflow tract reconstruction.
- Identify risk factors associated with graft complications.
Main Methods:
- Retrospective review of echocardiography data from 133 children (median age 30.9 months) who underwent graft implantation between 1999 and 2005.
- Follow-up duration ranged from 1 to 73 months.
Main Results:
- Early mortality was 8 patients; late mortality was 11 patients (2 graft-related).
- 92% of patients showed absent to mild valve regurgitation. Distal stenosis occurred in 25 patients, often related to small pulmonary arteries and young age.
- Five-year survival was 85.7%, freedom from explantation was 91%, and freedom from intervention for stenosis was 80%.
Conclusions:
- Bovine jugular vein grafts are a valuable conduit for pediatric right ventricular outflow tract reconstruction.
- Younger patient age and small pulmonary arteries are significant risk factors for distal conduit stenosis.
- Graft dilatation and calcification were not significant issues within 5 years.
Background:
We analyzed the results in two centers of using bovine jugular vein graft for right ventricular outflow tract reconstruction.
Methods:
From April 1999 to July 2005, 133 children with a median age of 30.9 months (range, 4 days to 19 years) underwent graft implantation. Echocardiography was performed during follow-up and retrospectively reviewed.
Results:
Nongraft-related early mortality occurred in 8 patients. Late mortality occurred in 11 patients, 2 late deaths were graft related (endocarditis). Median follow-up was 31.6 months (range, 1 to 73). Twelve patients received a new graft, because of endocarditis (3), distal pulmonary artery branch stenosis (4), graft obstruction caused by fibrosis (4), or thrombosis (1). Echocardiography Doppler studies showed good conduit function, with 92% of the patients having absent, trivial, or only mild valve regurgitation at last follow-up. A moderate degree of conduit stenosis due to external compression was observed in 2 patients. Twenty-five patients with otherwise intact conduits had hemodynamically significant distal stenosis. In most cases, the pulmonary branch stenosis was related to preoperative small pulmonary arteries and young age at operation. At 31.6 months, significant graft dilatation was observed in 4 grafts and was related to pulmonary artery branch obstruction or pulmonary hypertension. Calcification did not occur in 5 years time. Survival was 85.7%, freedom from conduit explantation was 91%, and freedom from intervention for pulmonary artery branch stenosis was 80% after 5 years.
Conclusions:
The bovine jugular vein graft is a valuable right ventricular outflow tract conduit, but younger age and small pulmonary arteries increase the risk of distal conduit stenosis.
