A Bovine Jugular Vein Conduit: A ten-year bi-institutional experience

Andrew C. Fiore, John Brown, Mark Turrentine, Mark Ruzmetov, Danny Huynh, Seth Hanley, Mark Rodefeld

Research output: Contribution to journalArticle

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Abstract

Background: We retrospectively reviewed the 12-year (1999 to 2010) clinical and echocardiographic performance of 232 bovine jugular vein conduits for extracardiac right ventricular outflow tract reconstruction in non-Ross patients. Methods: The bovine jugular vein conduit cohorts, group 1 (12 to 14 mm), group 2 (16 to 18 mm), and group 3 (20 to 22 mm), had mean follow-up of 48 ± 30 months. Graft dysfunction is defined as right ventricular outflow tract obstruction with peak echo Doppler gradient greater than 40 mm Hg or grade 3/4 valve regurgitation. Graft failure is the need for conduit replacement or transcatheter or surgical reintervention. Results: Early mortality (4 of 232; 2%) and late mortality (8 of 228; 3.5%) were not conduit related. Twenty-four conduits (10%) were explanted. Mean implant Z score was significantly lower for group 1 (1.7 ± 0.08 versus group 2, 2.7 ± 0.6, or group 3, 2.5 ± 1.5; p = 0.001). Ten-year actuarial survival (group 1, 84% versus 2, 100%, and 3, 99%; p = 0.001) and freedom from conduit dysfunction (group 1, 64%; group 2, 92%; and group 3, 90%) and failure (group 1, 75%; 2, 82%; and 3, 91%; p = 0.002) were significantly better for groups 2 and 3. Conclusions: Bovine jugular vein is an excellent immediate substitute for right ventricular outflow tract reconstruction, with early durability superior to that of pulmonary homografts reported at similar follow-up. Conduits larger than 14 mm have improved performance. Longer follow-up will define the structural integrity and efficacy of this prosthesis.

Original languageEnglish
Pages (from-to)183-192
Number of pages10
JournalAnnals of Thoracic Surgery
Volume92
Issue number1
DOIs
StatePublished - Jul 2011

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Jugular Veins
Transplants
Ventricular Outflow Obstruction
Mortality
Prostheses and Implants
Allografts
Lung
Survival

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

A Bovine Jugular Vein Conduit : A ten-year bi-institutional experience. / Fiore, Andrew C.; Brown, John; Turrentine, Mark; Ruzmetov, Mark; Huynh, Danny; Hanley, Seth; Rodefeld, Mark.

In: Annals of Thoracic Surgery, Vol. 92, No. 1, 07.2011, p. 183-192.

Research output: Contribution to journalArticle

Fiore, Andrew C. ; Brown, John ; Turrentine, Mark ; Ruzmetov, Mark ; Huynh, Danny ; Hanley, Seth ; Rodefeld, Mark. / A Bovine Jugular Vein Conduit : A ten-year bi-institutional experience. In: Annals of Thoracic Surgery. 2011 ; Vol. 92, No. 1. pp. 183-192.
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abstract = "Background: We retrospectively reviewed the 12-year (1999 to 2010) clinical and echocardiographic performance of 232 bovine jugular vein conduits for extracardiac right ventricular outflow tract reconstruction in non-Ross patients. Methods: The bovine jugular vein conduit cohorts, group 1 (12 to 14 mm), group 2 (16 to 18 mm), and group 3 (20 to 22 mm), had mean follow-up of 48 ± 30 months. Graft dysfunction is defined as right ventricular outflow tract obstruction with peak echo Doppler gradient greater than 40 mm Hg or grade 3/4 valve regurgitation. Graft failure is the need for conduit replacement or transcatheter or surgical reintervention. Results: Early mortality (4 of 232; 2{\%}) and late mortality (8 of 228; 3.5{\%}) were not conduit related. Twenty-four conduits (10{\%}) were explanted. Mean implant Z score was significantly lower for group 1 (1.7 ± 0.08 versus group 2, 2.7 ± 0.6, or group 3, 2.5 ± 1.5; p = 0.001). Ten-year actuarial survival (group 1, 84{\%} versus 2, 100{\%}, and 3, 99{\%}; p = 0.001) and freedom from conduit dysfunction (group 1, 64{\%}; group 2, 92{\%}; and group 3, 90{\%}) and failure (group 1, 75{\%}; 2, 82{\%}; and 3, 91{\%}; p = 0.002) were significantly better for groups 2 and 3. Conclusions: Bovine jugular vein is an excellent immediate substitute for right ventricular outflow tract reconstruction, with early durability superior to that of pulmonary homografts reported at similar follow-up. Conduits larger than 14 mm have improved performance. Longer follow-up will define the structural integrity and efficacy of this prosthesis.",
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AB - Background: We retrospectively reviewed the 12-year (1999 to 2010) clinical and echocardiographic performance of 232 bovine jugular vein conduits for extracardiac right ventricular outflow tract reconstruction in non-Ross patients. Methods: The bovine jugular vein conduit cohorts, group 1 (12 to 14 mm), group 2 (16 to 18 mm), and group 3 (20 to 22 mm), had mean follow-up of 48 ± 30 months. Graft dysfunction is defined as right ventricular outflow tract obstruction with peak echo Doppler gradient greater than 40 mm Hg or grade 3/4 valve regurgitation. Graft failure is the need for conduit replacement or transcatheter or surgical reintervention. Results: Early mortality (4 of 232; 2%) and late mortality (8 of 228; 3.5%) were not conduit related. Twenty-four conduits (10%) were explanted. Mean implant Z score was significantly lower for group 1 (1.7 ± 0.08 versus group 2, 2.7 ± 0.6, or group 3, 2.5 ± 1.5; p = 0.001). Ten-year actuarial survival (group 1, 84% versus 2, 100%, and 3, 99%; p = 0.001) and freedom from conduit dysfunction (group 1, 64%; group 2, 92%; and group 3, 90%) and failure (group 1, 75%; 2, 82%; and 3, 91%; p = 0.002) were significantly better for groups 2 and 3. Conclusions: Bovine jugular vein is an excellent immediate substitute for right ventricular outflow tract reconstruction, with early durability superior to that of pulmonary homografts reported at similar follow-up. Conduits larger than 14 mm have improved performance. Longer follow-up will define the structural integrity and efficacy of this prosthesis.

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