Three Indications for Bovine Jugular Vein Grafts in a Single Tertiary Centre in Jeddah: A Retrospective Study

Authors

  • Sameh Ibrahim Sersar King Abdullah Medical City (KAMC), Makkah, KSA and Mansoura University Hospitals, Mansoura, Egypt
  • Ayman A. Sallam Tanta University, Egypt
  • Mohammed M. Hassan KAMC Cardiac Surgery Department, Cairo University Hospitals and KAMC, Makkah, KSA
  • Mohamed Abdelzaher Critical Care Medicine Department, Cairo University Hospitals and KAMC, Makkah, KSA

DOI:

https://doi.org/10.12970/2311-052X.2014.02.01.6

Keywords:

Bovine jugular vein grafts, Contegra

Abstract

Introduction and Aim of the Work: Bovine jugular vein grafts(Contegra) can be used not only in the reconstruction of an abnormal right ventricular outflow tract (RVOT) but also for VSD repairs and as an extra-cardiac conduit for the Fontan circulation.(1-2-3-4-5). We aimed to present and review the preliminary results of contegra in the 3 different indications.

Patients and Methods: We reviewed the available charts of 22 patients who needed contegra as an RVOT reconstive graft, 23 cases for Fontan extracardiac conduits and 8 cases of VSD in a single tertiary centre in Jeddah in more than 8 years between 2002 and 2011. The available demographic data, operative, ECHO findings, results, complications and the follow up data are presented and analysed.

Results: Fifty three cases were included in this retrospective study from June 2002 to January 2011. The Median age at the time of operation was 3.5 years (range 1-26 years). The thirty days mortality was 7.5 % (four patients); one Fontan patient died because of arrhythmia & sepsis, the other Fontan one due to lately detected thrombosed Fontan connection. The 3rd patient was a case of Fallot tetralogy who died because of ventricular dysfunction and the 4th one was a repaired VSD died because of sepsis and DIC. Follow-up was available for 40 (75.4%) patients at a mean of 19.8 months (range 8-78 months) postoperatively.

Conclusion: The Contegra xenograft is a good conduit for RVOT reconstruction, a potential acceptable alternative conduit for the extracardiac Fontan connections and can be used to close the VSD if it is associated with one of the previous 2 indications.

References

Dave H, Mueggler O, Comber M, et al. Risk factor analysis of 170 single-institutional contegra implantations in pulmonary position. Ann Thorac Surg 2011; 91: 195-302. http://dx.doi.org/10.1016/j.athoracsur.2010.07.058

Dave HH, Buechel ER, Dodge-Khatami A, et al. Early insertion of a pulmonary valve for chronic regurgitation helps restoration of ventricular dimensions. Ann Thorac Surg 2005; 80: 1615-21. http://dx.doi.org/10.1016/j.athoracsur.2005.04.058

Buechel ER, Dave HH, Kellenberger CJ, et al. Remodelling of the right ventricle after early pulmonary valve replacement in children with repaired tetralogy of Fallot: assessment by cardiovascular magnetic resonance. Eur Heart J 2005; 26: 2721-7. http://dx.doi.org/10.1093/eurheartj/ehi581

Baslaim G. Expanding the utilization of Contegra for ventricular septal defect repair. J Card Surg 2008; 23: 528-9. http://dx.doi.org/10.1111/j.1540-8191.2007.00559.x

Baslaim G. Bovine valved xenograft (Contegra) conduit in the extracardiac Fontan procedure: the preliminary experience. J Card Surg. 2008; 23: 146-9. http://dx.doi.org/10.1111/j.1540-8191.2007.00524.x

Urso S, Rega F, Meuris B, et al. The Contegra conduit in the right ventricular outflow tract is an independent risk factor for graft replacement. Eur J Cardiothorac Surg 2011; 40: 603-9.

Ross DN, Somerville J. Correction of pulmonary atresia with a homograft aortic valve. Lancet 1966; 2: 1446-7. http://dx.doi.org/10.1016/S0140-6736(66)90600-3

Meyns B, Jashari R, Gewillig M, Mertens L, Koma´rek A, Lesaffre E, Budts W, Daenen W. Factors influencing the survival of cryopreserved homografts. The second homograft performs as well as the first. Eur J Cardiothorac Surg 2005; 28: 211-6. http://dx.doi.org/10.1016/j.ejcts.2005.03.041

Corno AF, Hurni M, Griffin H, et al. Bovine jugular vein as right ventricle-to-pulmonary artery valve conduit. J Heart Valve Dis 2002; 11: 242-7.

Breymann T, Thies WR, Boethig D, Goerg R, Blanz U, Koerfer R. Bovine valved venous xenografts for RVOT reconstruction: results after 71 implantations. Eur J Cardiothorac Surg 2002; 21: 703-10. http://dx.doi.org/10.1016/S1010-7940(02)00049-0

Boudjemline Y, Bonnet D, Agnoletti G, Vouhe´ P. Aneurysm of the right ventricular outflow following bovine valved venous conduit insertion. Eur J Cardiothorac Surg 2003; 23: 122-4. http://dx.doi.org/10.1016/S1010-7940(02)00660-7

Meyns B, Van Garsse L, Boshoff D, et al. The Contegra conduit in the right ventricular outflow tract induces supravalvular stenosis. J Thorac Cardiovasc Surg 2004; 128: 834-40.

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: 426-31. http://dx.doi.org/10.1111/j.0886-0440.2004.04083.x

Tiete AR, Sachweh JS, Roemer U, Kozlik-Feldmann R, Reichart B, Daebritz SH. Right ventricular outflow tract reconstruction with the Contegra bovine jugular vein conduit: a word of caution. Ann Thorac Surg 2004; 77: 2151-6. http://dx.doi.org/10.1016/j.athoracsur.2003.12.068

Breymann T, Blanz U, Wojtalik MA, et al. European Contegra multicentre study: 7-year results after 165 valved bovine jugular vein graft implantations. Thorac Cardiovasc Surg 2009; 57: 257-69. http://dx.doi.org/10.1055/s-0029-1185513

Kim SJ, Kim WH, Lim HG, Lee JY. Outcome of 200 patients after an extracardiac Fontan procedure. J Thorac Cardiovasc Surg 2008; 136: 108-16. http://dx.doi.org/10.1016/j.jtcvs.2007.12.032

Yuan SM. The Contegra valved bovine conduit: a biomaterial for the surgical treatment of congenital heart defects. Arq Bras Cardiol 2012; 99: 1159-66. http://dx.doi.org/10.1590/S0066-782X2012005000105

Iyer KS. The Contegra bovine jugular valved conduit: living up to expectations? Ann Pediatr Cardiol 2012; 5: 34-5.

MacIver RH, Permut LC, McMullan DM. Downsized contegra graft as a right ventricle-to-pulmonary artery conduit in the setting of mediastinitis. Ann Thorac Surg 2013; 96: 1077-8. http://dx.doi.org/10.1016/j.athoracsur.2013.01.039

Elefteriades JA, Youssef S, Rousou L, Nazer R. Novel valved graft modification of Cabrol fistula for bleeding after aortic root surgery. Ann Thorac Surg 2012; 94: 1741-3. http://dx.doi.org/10.1016/j.athoracsur.2012.05.114

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2014-03-21

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