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Contegra Bovine Jugular Vein and Matrix Decellularized Porcine Pulmonary Valve Conduits for Right Ventricular Outflow Tract Reconstruction in Pediatric Patients

Guido Oppido, Carlo Pace Napoleone, Simone Turci, Claudia D'Andrea, Valentina Gesuete, Emanuela Angeli, Gaetano Gargiulo.
S.Orsola Malpighi Hospital, Bologna, Italy.

OBJECTIVE:Homograft is still considered the conduit of choice for the right ventricular outflow tract reconstruction. Nevertheless, its lack of availability particularly in pediatric patients, prompts surgeons to identify an ideal alternative. The present study evaluates the outcome of Contegra bovine jugular veins and Matrix decellularized porcine pulmonary conduits implanted for reconstructing the right ventricular outflow tract in pediatric patients.
METHODS: From April 2000 to October 2010, 52 patients (mean age, 18±29 months) underwent 56 conduit implants (38 Contegra and 18 Matrix). Diagnoses were: Truncus arteriosus(21), ToF/PA (21), ToF/PS(5), PAIVS (2), PS (2), TGA/VSD/PS(1). End points were: reintervention, reoperation and onset of severe dysfunction meant as severe incompetence or severe stenosis of the valved conduit.
RESULTS:Six patients died (1only in the Matrix group), 4 early(7.7%) and 2 late(4.2%), none for conduit-related cause.Mean conduit sizes were 13±2 and 15±3 for Contegra and Matrix, respectively.The rate of overall conduit replacement was 17.1% for the Contegra versus 17.6% for the Matrix at a mean time of 50±31 and 34±10, respectively. The cause of replacement was: conduit stenosis(4), dilatation(1) and endocarditi (1) in the Contegra group; stenosis(2) and dilatation(1) in the Matrix group. Nineteen balloon dilatation procedures were required, seven on the pulmonary arteries and so not conduit-related. The remaining 12 procedures were done 8 (22.9%) in the Contegra group (mean time 24±15 months) and 4 (23.5%) in the Matrix group (mean time 20±17 months). In 11 cases the stenosis was at the distal anastomosis. All the survivors were followed-up with 3 month intervals Echocardiograms and severe incompetence of the conduit valve was detected in 29% and 17.6% of the patients of the Contegra and Matrix groups respectively at a mean time of 21±14 and 25±20. Age of less than 1 year, body surface area, pulmonary branches stenosis, and conduit size less than 14 mm were not identified as risk factors for premature failure.
CONCLUSIONS:Contegra and Matrix conduits can be considered valid for reconstructing the right ventricular outflow tract of pediatric patients although both similarly show a not negligible rate of early dysfunction, need for catheter intervention and replacement.
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