Contegra versus pulmonary homograft for right ventricular outflow tract reconstruction in newborns

Abstract

Objectives:Pulmonary homografts are standard alternatives to right ventricular outflow tract reconstruction in congenital heart surgery. Unfortunately, shortage and conduit failure by early calcifications and shrinking are observed for small-sized homografts in younger patients. In neonates, Contegra® 12 mm (Medtronic Inc., Minneapolis, Minnesota, United States of America) could be a valuable alternative, but conflicting evidence exists. There is no published study considering only newborns with heterogeneous pathologies. We retrospectively compared the outcomes of these two conduits in this challenging population.Methods:Patients who underwent a right ventricular outflow tract reconstruction between January 1992 and December 2014 at the Hôpital Universitaire des Enfants Reine Fabiola were included. We retrospectively collected and analysed demographic, echocardiographic, surgical, and follow-up data.Results:Of the 53 newborns who benefited from a right ventricular outflow tract reconstruction during the considered period, 30 received a Contegra 12 mm (mean age 15 ± 8 days), and 23 a small (9–14 mm) pulmonary homograft (mean age 10 ± 7 days). Overall mortality was 16.6% with Contegra versus 17.4% in the pulmonary homograft group (p = 0.98 log-rank). Operative morbidity and early re-operation for conduit failure were not significantly different between the two groups. Mean follow-up in this study is 121 ± 74 months. Survival free from re-operation was not different between the two groups (p = 0.15). Multivariable analysis showed that weight and significant early gradient were factors associated with anticipated conduit failure.Conclusions:Contegra 12 mm is a valid alternative to small pulmonary homografts in a newborn patient population. Trial registration: NCT03348397.

Conduits for Right Ventricular Outflow Tract Reconstruction in Infants and Young Children

“…There is no doubt that the bovine jugular vein conduit (BJVC), usually known as Contegra R conduit (Medtronic Inc., Minneapolis, Minnesota, USA), has achieved great success. It showed comparable (11,12) or even better (13)(14)(15) performance than homograft. Still, the durability of BJVC is very poor in infants (16).…”

Outcomes Following Heterotopic Placement of Right Ventricle to Pulmonary Artery Conduits

“…This finding is consistent with previous reports. [24][25][26] It has been proposed that PHs are more compliant than AH due to a higher elastin content and lower calcium level; this may render them more resistant to calcification, which results in conduit stenosis and valvar dysfunction. 26 Finally, RFS was better for patients with TA compared to other patients, despite the earlier age of RV-PA connection in the TA patients, supporting the concept that convoluted pathways of blood flow that are inherent in PA-VSD patients with RV-PA connections contribute to accelerated conduit deterioration.…”

The Role of Novel Transcatheter Procedures in Patients With Congenital Heart Disease

“…[18][19][20] The longevity of conduits and valves may differ, although all are shorter than the expected lifespan of the patient, making eventual reintervention necessary. [21][22][23][24][25][26][27]…”