Repair of congenital heart defects involving the right ventricular outflow tract may require the implantation of a right ventricle to pulmonary artery conduit. This conduit is likely to be replaced during childhood. This study compares the operative outcomes of the replacement procedure of Contegra® and homografts in pulmonary position.
From 1999 to 2016, 82 children underwent 87 right ventricle to pulmonary artery conduit replacements (60 Contegra® and 27 homografts). Demographics, operative and clinical data were obtained through a retrospective review of the medical records. The two groups were matched for comparison using propensity score matching. All the procedures were performed by the same team of surgeons.
No statistically significant difference was observed between the two groups when considering the operative data for anesthesia, surgery, cardiopulmonary bypass and aortic clamping durations. A peroperative complication rate of 13.47% and 15.36% in Contegra® and homograft replacement groups respectively (p value = 0.758) was observed. There was no difference regarding the blood loss and fluid input. No statistically significant difference was observed between the two groups for the post-operative morbidity. We considered the Pediatric Risk of Mortality (PRISM) score, the day of extubation, the day of withdrawal of inotropic drugs, the length of the intensive care unit stay and the length of hospital stay. The overall mortality is 2.3% but there is no statistically significant difference between the two groups.
Right ventricle to pulmonary artery conduit replacement procedure can be achieved with a low surgical morbidity or mortality, not influenced by the type of conduit that is replaced. Therefore, the choice between homograft or Contegra® for right ventricle to pulmonary artery reconstruction should not be influenced by the future surgical risk during the replacement procedure.
NCT03048071. Registered 9 February 2017 (retrospectively registered).
Goffin YA, Van Hoeck B, Jashari R, Soots G, Kalmar P. Banking of cryopreserved heart valves in Europe: assessment of a 10-year operation in the European homograft Bank (EHB). J Heart Valve Dis. 2000;9:207–14. PubMed
Tweddell JS, Pelech AN, Frommelt PC, Mussatto KA, Wyman JD, Fedderly RT, et al. Factors affecting longevity of homograft valves used in right ventricular outflow tract reconstruction for congenital heart disease. Circulation. 2000;102 suppl 3:Iii–130.
ESS T, Gersony WM, Altmann K, Solowiejczyk DE, Bevilacqua LM, Khan C, et al. Pulmonary position cryopreserved homografts: durability in pediatric Ross and non-Ross patients. J Thorac Cardiovasc Surg. 2005;130:282–6. CrossRef
Sandica E, Boethig D, Blanz U, Goerg R, Haas N, Laser K, et al. 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. Thorac Cardiovasc Surg. 2015;64:025–35. CrossRef
van Buuren S, Groothuis-Oudshoorn K. Mice: multivariate imputation by chained equations in R. J Stat Softw. 2011;Vol 1 Issue 3:2011. https://www.jstatsoft.org/index.php/jss/article/view/v045i03
Imai K, Ratkovic M. Robust estimation of inverse probability weights for marginal structural models. J Am Stat Assoc. 2015;110:1013–23. CrossRef
Pollack MM, Holubkov R, Funai T, Dean JM, Berger JT, Wessel DL, et al. The pediatric risk of mortality score: update 2015. Pediatr Crit Care Med J Soc Crit Care Med World Fed Pediatr Intensive Crit Care Soc. 2016;17:2–9.
Boethig D, Goerler H, Westhoff-Bleck M, Ono M, Daiber A, Haverich A, et al. Evaluation of 188 consecutive homografts implanted in pulmonary position after 20 years. Eur J Cardio-Thorac Surg Off J Eur Assoc Cardio-Thorac Surg. 2007;32:133–42. CrossRef
Rodefeld MD, Ruzmetov M, Turrentine MW, Brown JW. Reoperative right ventricular outflow tract conduit reconstruction: risk analyses at follow up. J Heart Valve Dis. 2008;17:119–26. discussion 126 PubMed
DLS M, Braud BE, Gunter KS, Carberry KE, Arrington KA, Heinle JS, et al. Encouraging results for the Contegra conduit in the problematic right ventricle–to–pulmonary artery connection. J Thorac Cardiovasc Surg. 2006;132:665–71. CrossRef
DLS M, Zafar F, Arrington KA, Gonzalez SM, ED MK, Heinle JS, et al. Repeat Sternotomy in congenital heart surgery: no longer a risk factor. Ann Thorac Surg. 2008;86:897–902. CrossRef
- Pulmonary valve replacement after right ventricular outflow tract reconstruction with homograft vs Contegra®: a case control comparison of mortality and morbidity
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