Related Experiment Video
Updated: Jun 8, 2026
Donor Posterior Atrial Flap Rotation for Left Atrial Cuff Reconstruction in Lung Transplantation
Published on: October 11, 2024
Homografts and xenografts for right ventricular outflow tract reconstruction: long-term results
Jan T Christenson1, Jorge Sierra, Norman E Colina Manzano
1Division of Cardiovascular Surgery, University Hospital of Geneva, Faculty of Medicine, University of Geneva, Geneva, Switzerland. jan.christenson@hcuge.ch
Insights
Cryopreserved homografts require more reoperations in children under 3 years old. Contegra grafts offer a lower reoperation rate, making them a suitable alternative for young patients needing right ventricular outflow tract reconstruction.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Biomaterials Science
Background:
- Cryopreserved valved homografts are standard for pediatric right ventricular outflow tract reconstruction.
- Accelerated fibrocalcification leads to early reoperation in young children (<3 years) using homografts.
- Bovine jugular vein conduits (Contegra) show promise, avoiding early fibrocalcification in this age group.
Purpose of the Study:
- To compare the long-term outcomes of homografts with midterm results of Contegra grafts.
- To evaluate reoperation rates in pediatric patients undergoing right ventricular outflow tract reconstruction.
- To assess the impact of blood group compatibility on homograft durability.
Main Methods:
- A retrospective study of 205 children undergoing right ventricular outflow tract reconstruction between 1993 and 2009.
- Patients received either cryopreserved aortic homografts (n=120) or Contegra grafts (n=85).
- Follow-up ranged from 6 months to 16 years, focusing on conduit dysfunction and reoperation necessity.
Main Results:
- Freedom from reoperation at 9 years was 89.0% for Contegra, 63.0% for non-iso homografts, and 85.7% for iso-homografts.
- Early reoperation (within 2 years) due to fibrocalcification/stenosis occurred in 1.1% of Contegra recipients versus 6.7% of non-iso homograft recipients.
- No significant difference in hospital or graft-unrelated deaths between the groups.
Conclusions:
- Blood group-incompatible homografts have a higher early reoperation rate than compatible ones.
- Contegra grafts demonstrate a very low early reoperation rate, suitable for neonates and children under 3.
- Blood group compatibility is less critical for homografts in children over 3 years old.
Background:
Cryopreserved valved homografts are the most commonly used conduit for right ventricular outflow tract reconstruction in children. Early need for reoperation owing to accelerated fibrocalcification has been observed in neonates and children younger than 3 years. A valved bovine jugular vein conduit, Contegra, has shown good early results, without early accelerated fibrocalcification even in the very young patients. This study determined long-term results of homografts and midterm results of Contegra grafts, with special emphasis on reoperation rate.
Methods:
Between January 1993 and March 2009, 205 children received cryopreserved aortic homografts (n = 120, 66 blood group compatible [iso] and 54 non-blood group compatible [non-iso]) or Contegra grafts (n = 85, introduced in January 2000) for right ventricular outflow tract reconstruction and were followed from 6 months to 16 years. Primary diagnosis was tetralogy of Fallot (47%), pulmonary stenosis and atresia (19%), and truncus arteriosus (11%). Conduit dysfunction and need for reoperation were evaluated during follow-up.
Results:
There were no hospital deaths in the homograft group and 2 deaths of conduit-unrelated cause in the Contegra group, During follow-up 3 patients died in the homograft group from graft-unrelated cause, and none died in the Contegra group. Early reoperation as a result of fibrocalcification and stenosis (within 2 years) was required in 1 Contegra graft patient (1.1%) compared with 8 patients in the homograft group (6.7%), all non-iso. Freedom from reoperation for Contegra grafts was 89.0% at 9 years, compared with non-iso homografts 63.0% and iso-homografts 85.7%.
Conclusions:
Non-blood group-compatible homografts have a significantly higher early reoperation rate than blood group-compatible homografts. Contegra grafts have a very low early reoperation rate and could therefore be used in neonates and children younger than 3 years of age, if a blood group-compatible homograft cannot be found. In children older than 3 years blood group compatibility is less important.
