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Erschienen in: Pediatric Cardiology 4/2019

18.03.2019 | Original Article

Outcomes of Prosthetic Valved Conduits for Right Ventricular Outflow Tract Reconstruction

verfasst von: Hao Chen, Guocheng Shi, Lisheng Qiu, Shunmin Wang, Huiwen Chen, Zhiwei Xu

Erschienen in: Pediatric Cardiology | Ausgabe 4/2019

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Abstract

There are limited data regarding the implantation of prosthetic valved conduits for right outflow tract reconstruction in pediatric patients in China. A retrospective review of 128 patients undergoing conduits implantation with a median follow-up of 33.3 months (range, 3.3 months to 10.1 years) was performed between 2009 and 2018. Multivariate Cox regression model was used to analyze the risk factors for mortality, reintervention and endocarditis. Freedom from reintervention and endocarditis were plotted using the Kaplan–Meier curve. Hospital mortality was 7.8%, and the late mortality was 3.1%. Patient survival at 1, 5 and 10 years was 92.2%, 87.1% and 84.3%, respectively. Freedom from reintervention at 1 and 5 years was 94.1% and 60.9%. Small size conduit (p = 0.019) and previous palliation (p < 0.001) were predictive of reintervention. Ten conduits developed endocarditis at a median of 4.8 years after implantation. Freedom from endocarditis at 1, 5 and 10 years was 99.1%, 93.0% and 58.0%, respectively. Diffuse stenosis of the conduit (p = 0.003) was an independent risk factor for late endocarditis. Both bovine jugular venous conduits and bovine pericardial prosthetic conduits are associated with acceptable outcomes. Reintervention remains high in patients who have smaller size conduit and undergo previous palliation. It is plausible that the suboptimal flow may be one of major mechanisms involved in the development of late endocarditis.
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Literatur
1.
Zurück zum Zitat Boethig D, Thies WR, Hecker H, Breymann T (2005) Mid-term course after pediatric right ventricular outflow tract reconstruction: a comparison of homografts, porcine xenografts and Contegras. Eur J Cardiothorac Surg 27(1):58–66CrossRefPubMed Boethig D, Thies WR, Hecker H, Breymann T (2005) Mid-term course after pediatric right ventricular outflow tract reconstruction: a comparison of homografts, porcine xenografts and Contegras. Eur J Cardiothorac Surg 27(1):58–66CrossRefPubMed
2.
Zurück zum Zitat Hickey EJ, McCrindle BW, Blackstone EH, Yeh T Jr, Pigula F, Clarke D et al (2008) Jugular venous valved conduit (Contegra) matches allograft performance in infant truncus arteriosus repair. Eur J Cardiothorac Surg 33(5):890–898CrossRefPubMed Hickey EJ, McCrindle BW, Blackstone EH, Yeh T Jr, Pigula F, Clarke D et al (2008) Jugular venous valved conduit (Contegra) matches allograft performance in infant truncus arteriosus repair. Eur J Cardiothorac Surg 33(5):890–898CrossRefPubMed
3.
Zurück zum Zitat Christenson JT, Sierra J, Colina Manzano NE, Jolou J, Beghetti M, Kalangos A (2010) Homografts and xenografts for right ventricular outflow tract reconstruction: long-term results. Ann Thorac Surg 90(4):1287–1293CrossRefPubMed Christenson JT, Sierra J, Colina Manzano NE, Jolou J, Beghetti M, Kalangos A (2010) Homografts and xenografts for right ventricular outflow tract reconstruction: long-term results. Ann Thorac Surg 90(4):1287–1293CrossRefPubMed
4.
Zurück zum Zitat Prior N, Alphonso N, Arnold P, Peart I, Thorburn K, Venugopal P et al (2011) Bovine jugular vein valved conduit: up to 10 years follow-up. J Thorac Cardiovasc Surg 141(4):983–987CrossRefPubMed Prior N, Alphonso N, Arnold P, Peart I, Thorburn K, Venugopal P et al (2011) Bovine jugular vein valved conduit: up to 10 years follow-up. J Thorac Cardiovasc Surg 141(4):983–987CrossRefPubMed
5.
Zurück zum Zitat Shinkawa T, Tang X, Gossett JM, Mustafa T, Hategekimana F, Watanabe F et al (2015) Valved polytetrafluoroethylene conduits for right ventricular outflow tract reconstruction. Ann Thorac Surg 100(1):129–137CrossRefPubMed Shinkawa T, Tang X, Gossett JM, Mustafa T, Hategekimana F, Watanabe F et al (2015) Valved polytetrafluoroethylene conduits for right ventricular outflow tract reconstruction. Ann Thorac Surg 100(1):129–137CrossRefPubMed
6.
Zurück zum Zitat Ootaki Y, Welch AS, Walsh MJ, Quartermain MD, Williams DA, Ungerleider RM (2018) Medium-term outcomes after implantation of expanded polytetrafluoroethylene valved conduit. Ann Thorac Surg 105(3):843–850CrossRefPubMed Ootaki Y, Welch AS, Walsh MJ, Quartermain MD, Williams DA, Ungerleider RM (2018) Medium-term outcomes after implantation of expanded polytetrafluoroethylene valved conduit. Ann Thorac Surg 105(3):843–850CrossRefPubMed
7.
Zurück zum Zitat Albanesi F, Sekarski N, Lambrou D, Von Segesser LK, Berdajs DA (2014) Incidence and risk factors for Contegra graft infection following right ventricular outflow tract reconstruction: long-term results. Eur J Cardiothorac Surg 45(6):1070–1074CrossRefPubMed Albanesi F, Sekarski N, Lambrou D, Von Segesser LK, Berdajs DA (2014) Incidence and risk factors for Contegra graft infection following right ventricular outflow tract reconstruction: long-term results. Eur J Cardiothorac Surg 45(6):1070–1074CrossRefPubMed
8.
Zurück zum Zitat Ugaki S, Rutledge J, Al Aklabi M, Ross DB, Adatia I, Rebeyka IM (2015) 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 99(1):140–146CrossRefPubMed Ugaki S, Rutledge J, Al Aklabi M, Ross DB, Adatia I, Rebeyka IM (2015) 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 99(1):140–146CrossRefPubMed
9.
Zurück zum Zitat Mery CM, Guzmán-Pruneda FA, De León LE, Zhang W, Terwelp MD, Bocchini CE et al (2016) Risk factors for development of endocarditis and reintervention in patients undergoing right ventricle to pulmonary artery valved conduit placement. J Thorac Cardiovasc Surg 151(2):432–439CrossRefPubMed Mery CM, Guzmán-Pruneda FA, De León LE, Zhang W, Terwelp MD, Bocchini CE et al (2016) Risk factors for development of endocarditis and reintervention in patients undergoing right ventricle to pulmonary artery valved conduit placement. J Thorac Cardiovasc Surg 151(2):432–439CrossRefPubMed
10.
Zurück zum Zitat Boethig D, Schreiber C, Hazekamp M, Blanz U, Prêtre R, Asfour B et al (2012) Risk factors for distal Contegra stenosis: results of a prospective European multicentre study. Thorac Cardiovasc Surg 60(3):195–204CrossRefPubMed Boethig D, Schreiber C, Hazekamp M, Blanz U, Prêtre R, Asfour B et al (2012) Risk factors for distal Contegra stenosis: results of a prospective European multicentre study. Thorac Cardiovasc Surg 60(3):195–204CrossRefPubMed
11.
Zurück zum Zitat Shebani SO, McGuirk S, Baghai M, Stickley J, De Giovanni JV, Bu’lock FA et al (2006) Right ventricular outflow tract reconstruction using Contegra valved conduit: natural history and conduit performance under pressure. Eur J Cardiothorac Surg 29(3):397–405CrossRefPubMed Shebani SO, McGuirk S, Baghai M, Stickley J, De Giovanni JV, Bu’lock FA et al (2006) Right ventricular outflow tract reconstruction using Contegra valved conduit: natural history and conduit performance under pressure. Eur J Cardiothorac Surg 29(3):397–405CrossRefPubMed
12.
Zurück zum Zitat Urso S, Rega F, Meuris B, Gewillig M, Eyskens B, Daenen W et al (2011) The Contegra conduit in the right ventricular outflow tract is an independent risk factor for graft replacement. Eur J Cardiothorac Surg 40(3):603–609PubMed Urso S, Rega F, Meuris B, Gewillig M, Eyskens B, Daenen W et al (2011) The Contegra conduit in the right ventricular outflow tract is an independent risk factor for graft replacement. Eur J Cardiothorac Surg 40(3):603–609PubMed
13.
Zurück zum Zitat Wojtalik M, Mrowczynski W, Zeromski J, Bartkowski R (2003) Does contegra xenograft implantation evoke cellular immunity in children? Interact Cardiovasc Thorac Surg 2(3):273–278CrossRefPubMed Wojtalik M, Mrowczynski W, Zeromski J, Bartkowski R (2003) Does contegra xenograft implantation evoke cellular immunity in children? Interact Cardiovasc Thorac Surg 2(3):273–278CrossRefPubMed
14.
Zurück zum Zitat Berdajs DA, Mosbahi S, Charbonnier D, Hullin R, von Segesser LK (2015) Analysis of flow dynamics in right ventricular outflow tract. J Surg Res 197(1):50–57CrossRefPubMed Berdajs DA, Mosbahi S, Charbonnier D, Hullin R, von Segesser LK (2015) Analysis of flow dynamics in right ventricular outflow tract. J Surg Res 197(1):50–57CrossRefPubMed
15.
Zurück zum Zitat Meyns B, Van Garsse L, Boshoff D, Eyskens B, Mertens L, Gewillig M et al (2004) The Contegra conduit in the right ventricular outflow tract induces supravalvular stenosis. J Thorac Cardiovasc Surg 128(6):834–840CrossRefPubMed Meyns B, Van Garsse L, Boshoff D, Eyskens B, Mertens L, Gewillig M et al (2004) The Contegra conduit in the right ventricular outflow tract induces supravalvular stenosis. J Thorac Cardiovasc Surg 128(6):834–840CrossRefPubMed
16.
Zurück zum Zitat Zhang HF, Chen G, Ye M, Yan XG, Tao QL, Jia B (2017) Mid- to long-term outcomes of bovine jugular vein conduit implantation in Chinese children. J Thorac Dis 9(5):1234–1239CrossRefPubMedPubMedCentral Zhang HF, Chen G, Ye M, Yan XG, Tao QL, Jia B (2017) Mid- to long-term outcomes of bovine jugular vein conduit implantation in Chinese children. J Thorac Dis 9(5):1234–1239CrossRefPubMedPubMedCentral
17.
Zurück zum Zitat Beckerman Z, De León LE, Zea-Vera R, Mery CM, Fraser CD Jr (2018) High incidence of late infective endocarditis in bovine jugular vein valved conduits. J Thorac Cardiovasc Surg 156(2):728–734CrossRefPubMed Beckerman Z, De León LE, Zea-Vera R, Mery CM, Fraser CD Jr (2018) High incidence of late infective endocarditis in bovine jugular vein valved conduits. J Thorac Cardiovasc Surg 156(2):728–734CrossRefPubMed
18.
Zurück zum Zitat Tiete AR, Sachweh JS, Roemer U, Kozlik-Feldmann R, Reichart B, Daebritz SH (2004) Right ventricular outflow tract reconstruction with the Contegra bovine jugular vein conduit: a word of caution. Ann Thorac Surg 77(6):2151–2156CrossRefPubMed Tiete AR, Sachweh JS, Roemer U, Kozlik-Feldmann R, Reichart B, Daebritz SH (2004) Right ventricular outflow tract reconstruction with the Contegra bovine jugular vein conduit: a word of caution. Ann Thorac Surg 77(6):2151–2156CrossRefPubMed
19.
Zurück zum Zitat Morales DLS, Braud BE, Gunter KS, Carberry KE, Arrington KA, Heinle JS et al (2006) Encouraging results for the Contegra conduit in the problematic right ventricle–to–pulmonary artery connection. J Thorac Cardiovasc Surg 132(3):665–671CrossRefPubMed Morales DLS, Braud BE, Gunter KS, Carberry KE, Arrington KA, Heinle JS et al (2006) Encouraging results for the Contegra conduit in the problematic right ventricle–to–pulmonary artery connection. J Thorac Cardiovasc Surg 132(3):665–671CrossRefPubMed
20.
Zurück zum Zitat Baltimore RS, Gewitz M, Baddour LM, Beerman LB, Jackson MA, Lockhart PB et al (2015) Infective endocarditis in childhood: 2015 update: a scientific statement from the American Heart Association. Circulation 132(15):1487–1515CrossRefPubMed Baltimore RS, Gewitz M, Baddour LM, Beerman LB, Jackson MA, Lockhart PB et al (2015) Infective endocarditis in childhood: 2015 update: a scientific statement from the American Heart Association. Circulation 132(15):1487–1515CrossRefPubMed
21.
Zurück zum Zitat Jalal Z, Galmiche L, Lebeaux D, Villemain O, Brugada G, Patel M et al (2015) Selective propensity of bovine jugular vein material to bacterial adhesions: an in-vitro study. Int J Cardiol 198:201–205CrossRefPubMed Jalal Z, Galmiche L, Lebeaux D, Villemain O, Brugada G, Patel M et al (2015) Selective propensity of bovine jugular vein material to bacterial adhesions: an in-vitro study. Int J Cardiol 198:201–205CrossRefPubMed
22.
Zurück zum Zitat Schoen FJ, Levy RJ (1984) Bioprosthetic heart valve failure: pathology and pathogenesis. Cardiol Clin 2(4):717–739CrossRefPubMed Schoen FJ, Levy RJ (1984) Bioprosthetic heart valve failure: pathology and pathogenesis. Cardiol Clin 2(4):717–739CrossRefPubMed
23.
Zurück zum Zitat Veloso TR, Claes J, Van Kerckhoven S, Ditkowski B, Hurtado-Aguilar LG, Jockenhoevel S et al (2018) Bacterial adherence to graft tissues in static and flow conditions. J Thorac Cardiovasc Surg 155(1):325–332CrossRefPubMed Veloso TR, Claes J, Van Kerckhoven S, Ditkowski B, Hurtado-Aguilar LG, Jockenhoevel S et al (2018) Bacterial adherence to graft tissues in static and flow conditions. J Thorac Cardiovasc Surg 155(1):325–332CrossRefPubMed
Metadaten
Titel
Outcomes of Prosthetic Valved Conduits for Right Ventricular Outflow Tract Reconstruction
verfasst von
Hao Chen
Guocheng Shi
Lisheng Qiu
Shunmin Wang
Huiwen Chen
Zhiwei Xu
Publikationsdatum
18.03.2019
Verlag
Springer US
Erschienen in
Pediatric Cardiology / Ausgabe 4/2019
Print ISSN: 0172-0643
Elektronische ISSN: 1432-1971
DOI
https://doi.org/10.1007/s00246-019-02081-8

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