Pulmonary Valve Replacement in Congenital Heart Disease - A Performance Comparison of the Supported vs. Unsupported Bovine Jugular Vein Conduit
Erin T. Lueth, MD, Dale A. Burkett, MD, Bruce F. Landeck, MD, John T. Brinton, PhD, Maxene R. Meier, BS, Michal Schafer, PhD, Jessica M. Coffin, Katja M. Gist, DO, Max B. Mitchell, MD.
Children's Hospital Colorado, Aurora, CO, USA.
Objective(s): The Contegra Bovine Jugular Vein (BJV) conduit is commonly used for pulmonary valve replacement in pediatric patients. BJV conduits are available in supported and unsupported versions. The purpose of this study was to compare outcomes of supported vs. unsupported BJV conduits.
Methods: Retrospective review of patients < 18 years of age undergoing BJV placement (2009-2015) in a single center. Blinded cardiologists reviewed post-operative, 6, 12, 24, and 36-month echocardiograms and the last available echocardiogram prior to any valve related event or death. Conduit stenosis (m/s), insufficiency (≦mild vs. ≧moderate), and right ventricular (RV) function (normal vs. abnormal) were assessed. Cox proportional model was applied to evaluate the prognostic value of conduit type to predict conduit related outcomes (reintervention, survival). Kaplan-Meier analysis was used to compare valve longevity.
Results: 89 BJV conduits were placed (32 supported, 57 unsupported). Unsupported BJV had less stenosis on post-operative and 12-month echocardiograms (p=0.016, p=0.009). Gradients in both groups were mild at these time points, and not different on subsequent follow-up. Regurgitation and RV function did not differ at any time point. Fewer interventions were required for supported BJV during the first 3 years. Overall freedom from replacement or reintervention was not different between valve types at median follow-up of 3.6 yrs.
Conclusions:
Supported BJV exhibited mild gradients more commonly during early follow-up, but fewer reinterventions in the first 3 years. Overall valve longevity was similar. Our data suggest a slight advantage to the supported BJV with less reintervention during early follow-up.
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