Right ventricular outflow tract reconstruction: what conduit to use? Homograft or Contegra?

Both cryopreserved homografts and glutaraldehyde fixed bovine jugular vein grafts (Contegra) are used as conduits for right ventricular outflow tract (RVOT) reconstructions in children. Both types of conduits have their pros and cons vividly described in the literature, but so far only a few comparative studies have been presented.

Between 1993 and 2005, 88 aortic homografts (54 blood-group compatible, iso, and 34 nonblood-group compatible, non-iso) and 50 Contegra conduits were implanted for RVOT reconstruction. Mean age was 4.9 +/- 3.6 years, ranging from 1 month to 15 years. The two important primary diagnoses were tetralogy of Fallot (61%), and double-outlet right ventricle with pulmonary stenosis (12%). There were no demographic differences between the groups. The mean graft diameter was 19 mm (homografts) and 15 mm (Contegra).

There were no hospital deaths in the homograft group, whereas 1 patient died of graft unrelated causes in the Contegra group. Postoperative mean gradient was 14.5 +/- 11.2 mm Hg (homografts) and 19.8 +/- 11.5 mm Hg (Contegra). Freedom from graft dysfunction and reoperation at 2, 5, and 7 years was 88.9%, 87.6%, and 81.3% for all homografts; 100%, 97.4%, and 93.8% for homograft iso; 79.9%, 76.9%, and 66.6% for homograft non-iso; and 94.0%, 90.7%, and 90.7% for Contegra grafts. Moderate valvar regurgitation was seen in 3.4% (homografts) and 8.0% (Contegra). No supravalvar lesions were observed in either group.

Blood-group compatible cryopreserved homografts and Contegra conduits for RVOT reconstruction have very similar performance as long as 7 years postoperatively, and are significantly superior to nonblood-group compatible homografts.