The Contegra conduit in the right ventricular outflow tract induces supravalvular stenosis

Meyns, Bart; VANGARSSE, L; Boshoff, Derize; Eyskens, Bénédicte; Mertens, Laurence; Gewillig, M.; Fieuws, Steffen; Verbeken, Erik; Daenen, Woud

doi:10.1016/s0022-5223(04)01173-0

Cited by 27 publications

(38 citation statements)

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“…Secondly, we realise rigorous everting vascular sutures when using Contegra to avoid exposure of the external structure of the conduit with intravascular compartment that could lead to the classical distal stenosis observed in Contegra. 11 These precautions may explain the lower incidence of distal stenosis on the suture line secondary to peal-growing and acute conduit thrombosis. However, despite our policy of anticoagulation, we observed three cases of early Contegra cusp thrombosis without the need for early re-operation but none in the pulmonary homograft group (p = 0.11).…”

Section: Discussionmentioning

confidence: 99%

“…The initial experience with Contegra was promising, [6][7][8] but early contradictory reports rapidly tempered the optimism. [9][10][11] In fact, conflicting evidence exists about the performances of this conduit, particularly when considering young patients and small-sized conduits. 12 Even if first experiences with Contegra ranked them at the level of pulmonary homograft, [6][7][8] some concerns rapidly appeared: aneurism development, 9 supravalvular stenosis, acute thrombosis in small infants, 13 and early conduit insufficiency notably in small diameters 12 (12-14 mm).…”

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confidence: 99%

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

et al. 2019

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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.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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

et al. 2019

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“…All the reports on any type of right ventricle-topulmonary artery (RV-PA) replacement are better in mid-term follow-up terms with regard to freedom from reoperation or reintervention than our present series. However, some authors detected neointimal thickening together with supravalvular stenosis at the anastomotic site and preterm degeneration in conjunction with this valve type [16]. The different valve types are difficult to compare because of selection bias and surgical preferences.…”

Section: Discussionmentioning

confidence: 99%

No-React® Injectable BioPulmonic™ Valves Re-evaluated: Discouraging Follow-up Results

Siepe¹,

Höhn²,

Fleck³

et al. 2016

Thorac cardiovasc Surg

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OBJECTIVES: The No-React® Injectable BioPulmonic™ valve (BioIntegral) was introduced for minimally invasive off-pump replacement of the pulmonary valve almost 10 years ago. We present our mid-to long-term follow-up results. METHODS: We conducted a retrospective analysis of all 7 patients treated at our institution at the median age of 9 (range 1-24) years. The children underwent cardiac catheterization when worsening strain on the right heart was suspected after examining their medical history and/or observing significant changes on echocardiography. RESULTS: After a median follow-up period lasting 5.2 (range 0.7-6.7) years, all patients presented the indication for recatheterization, particularly because the maximum instantaneous velocity measured by Doppler had revealed systolic gradients of a median 63 (dP 18-74) mmHg across the right ventricular outflow. Catheterization confirmed severe stenosis in 2, and moderate stenosis together with moderate insufficiency in 4 patients. We observed two principal failure mechanisms: technical problems resulting from poor alignment to the right ventricular outflow tract and structural problems leading to neointimal proliferation even in cases with appropriate prosthesis positioning. At median of 5.7 (0.7-7) years after implantation, 6 of the 7 patients underwent valve rereplacement. Redo surgery was necessary in 3, and percutaneous valve-in-valve implantation in the remaining 3 patients. Histological analysis of two explanted valves confirmed significant neointima proliferation and thickened valve cusps leading to stenosis of the graft. CONCLUSIONS: These mid-term results after implantation of the No-React® Injectable BioPulmonic™ valve are disappointing. Graft failure was mainly due to neointimal formation and valve malposition.

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“…For Shoenhoff and coworkers [11], the first cause of graft failure was progressive stenosis with frequent formation of a stenotic membrane at the distal anastomosis. Other reports also emphasized the presence of stenosis at the pulmonary anastomosis imputed to excessive intimal peel formation and perigraft scarring [18,19].…”

Section: Discussionmentioning

confidence: 99%

MR and CT imaging of pulmonary valved conduits in children and adolescents: normal appearance and complications

et al. 2014

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The Contegra conduit in the right ventricular outflow tract induces supravalvular stenosis

Abstract: The Contegra conduit induces a neointimal proliferation at the level of the pulmonary anastomosis. This leads to a high incidence of severe stenosis at intermediate-term follow-up.

Cited by 27 publications

References 0 publications

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

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

No-React® Injectable BioPulmonic™ Valves Re-evaluated: Discouraging Follow-up Results

MR and CT imaging of pulmonary valved conduits in children and adolescents: normal appearance and complications

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