Comparative study of modified HeRO grafts using bovine carotid artery as conduits versus polytetrafluoreythylene

Hemodialysis reliable outflow (HeRO) device is currently the only option for hemodialysis for catheter-dependent dialysis patients with central venous stenosis who are poor candidates of fistulas and grafts. The proprietary HeRO device is connected to a standard polytetrafluorethylene (PTFE) conduit. Previous studies have showed decreased rates of infection using bovine carotid artery graft (BCAG) compared to the PTFE graft for arteriovenous grafts (AVG). This is the first study to compare the use of BCAG to PTFE for HeRO grafts.

From Jan 2015 to Dec 2022 we inserted 83 HeRO grafts on ESRD patients, 40 cases used the standard PTFE graft as the conduit connected to the HeRO component and 43 cases used the BCAG grafts. We did a 2 year follow up review on all the patients using the Kaplan Meier's survival analysis to compare the primary, primary-assisted patency and secondary patency, graft lifespan comparison, infection and complications.

PTFE was associated with significantly increased rates of infection compared to BCAG (40% vs 16.3%, p = 0.026). Comparing BCAG versus PTFE, primary patency was 58.4% versus 59% at 6 months (p = 0.82) and 34.9% versus 34.1% at 1 year (p = 0.88). Primary-assisted patency was 88.6% versus 80.6% at 6 months (p = 0.35) and 69.7% versus 54.6% at 1 year (p = 0.21). Secondary patency was 94.3% versus 85.7% (p = 0.23) at 6 months and 82.4% versus 59.1% at 1 year (p = 0.12).

Bovine carotid artery grafts are comparable in primary patency, primary-assisted patency, and secondary patency versus PTFE. Number of interventions required and done were similar in both groups. BCAG was associated with lower rates of infection compared to PTFE. BCAG is an acceptable conduit for HeRO graft and may be a better option compared to PTFE.