Bovine Jugular Veins versus Homografts in the Pulmonary Position: An Analysis across Two Centers and 711 Patients—Conventional Comparisons and Time Status Graphs as a New Approach

Abstract

Background Various diseases and diversity in implantation ages, together with evolving diagnostic and therapeutic options, hinder comparative evaluations of long-term outcomes for valved conduits used for reconstruction of the right ventricular outflow tract (RVOT). We combined two common evaluation methods to optimally use information obtained by pooling the raw data from two high volume centers, each with very regular follow-up procedures, with the aim of analyzing durability differences between conventional homografts and bovine jugular veins.

Patients and Methods In the period 1985 to 2012, a total of 444 bovine jugular veins and 267 homografts were implanted, and 6,738 postoperative examinations took place. Evaluations included age-stratified Kaplan–Meier analyses, Cox regression models, and time status graphs, the third showing age-group stratified, time-related frequencies of intact, insufficient, stenotic, both insufficient and stenotic, and postinterventional conduits below the freedom from explantation curve. They take into account interventions, explantations, and the nonterminal character of echocardiographic findings.

Results The durability of intact bovine jugular veins in children and young adults is not inferior to that of homografts. Averaged over the first 12 years after implantation, the age groups < 25 years in fact showed advantages for bovine jugular vein recipients. The average fraction of patients younger than 25 years whose conduits were not explanted, postinterventional, stenotic, insufficient, or stenotic and insufficient was at least 10% higher in recipients of bovine jugular veins than in homograft recipients.

Conclusion According to the time status graphs, the use of bovine jugular veins for RVOT in patients younger than 25 years appears to lead to superior results when compared with cryopreserved homografts.

Keywords

pulmonary arteries/veins - pulmonary valve - congenital heart disease - valve implantation - statistics

^* Both first authors contributed equally to this article.

• References

• 1 Boethig D, Goerler H, Westhoff-Bleck M , et al. Evaluation of 188 consecutive homografts implanted in pulmonary position after 20 years. Eur J Cardiothorac Surg 2007; 32 (1) 133-142
• 2 Boethig D, Westhoff-Bleck M, Hecker H , et al. Bovine jugular veins in the pulmonary position in adults — 5 years' experience with 64 implantations. Thorac Cardiovasc Surg 2009; 57 (4) 196-201
• 3 Boethig D, Thies WR, Hecker H, Breymann T. Mid term course after pediatric right ventricular outflow tract reconstruction: a comparison of homografts, porcine xenografts and Contegras. Eur J Cardiothorac Surg 2005; 27 (1) 58-66
• 4 Breymann T, Boethig D, Goerg R, Thies WR. The Contegra bovine valved jugular vein conduit for pediatric RVOT reconstruction: 4 years experience with 108 patients. J Card Surg 2004; 19 (5) 426-431
• 5 Mokhles MM, Charitos EI, Stierle U , et al. The fate of pulmonary conduits after the Ross procedure: longitudinal analysis of the German-Dutch Ross registry experience. Heart 2013; 99 (24) 1857-1866
• 6 Andrinopoulou ER, Rizopoulos D, Jin R, Bogers AJ, Lesaffre E, Takkenberg JJ. An introduction to mixed models and joint modeling: analysis of valve function over time. Ann Thorac Surg 2012; 93 (6) 1765-1772
• 7 Poynter JA, Eghtesady P, McCrindle BW , et al; Congenital Heart Surgeons' Society. Association of pulmonary conduit type and size with durability in infants and young children. Ann Thorac Surg 2013; 96 (5) 1695-1701 , discussion 1701–1702
• 8 Karamlou T, Blackstone EH, Hawkins JA , et al; Pulmonary Conduit Working Group for the members of the Congenital Heart Surgeons Society. Can pulmonary conduit dysfunction and failure be reduced in infants and children less than age 2 years at initial implantation?. J Thorac Cardiovasc Surg 2006; 132 (4) 829-838
• 9 Christenson JT, Sierra J, Colina Manzano NE, Jolou J, Beghetti M, Kalangos A. Homografts and xenografts for right ventricular outflow tract reconstruction: long-term results. Ann Thorac Surg 2010; 90 (4) 1287-1293
• 10 Morales DL, Braud BE, Gunter KS , et al. Encouraging results for the Contegra conduit in the problematic right ventricle-to-pulmonary artery connection. J Thorac Cardiovasc Surg 2006; 132 (3) 665-671
• 11 Cebotari S, Tudorache I, Ciubotaru A , et al. Use of fresh decellularized allografts for pulmonary valve replacement may reduce the reoperation rate in children and young adults: early report. Circulation 2011; 124 (11, Suppl): S115-S123
• 12 Ugaki S, Rutledge J, Al Aklabi M, Ross DB, Adatia I, Rebeyka IM. An increased incidence of conduit endocarditis in patients receiving bovine jugular vein grafts compared to cryopreserved homograft for right ventricular outflow reconstruction. Ann Thorac Surg 2015; 99 (1) 140-146
• 13 Albanesi F, Sekarski N, Lambrou D, Von Segesser LK, Berdajs DA. Incidence and risk factors for Contegra graft infection following right ventricular outflow tract reconstruction: long-term results. Eur J Cardiothorac Surg 2014; 45 (6) 1070-1074
• 14 Yong MS, Yim D, d'Udekem Y , et al. Medium-term outcomes of bovine jugular vein graft and homograft conduits in children. ANZ J Surg 2015; 85 (5) 381-385