Comparison of bovine jugular vein with pulmonary homograft conduits in children less than 2 years of age

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

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

Objectives: The optimal pulmonary valved conduit for infants and small children remains controversial. This report compares the initial insertion outcome of small caliber bovine jugular vein (BJV) (12-14mm) with pulmonary homografts (PHs) (10-15mm) in patients under age 2. Methods: From December 1998 to August 2009, 84 children (mean age 8.4 ± 8.5 months) received BJV (n=51) or PH (n=32) conduits. Mean Z score for BJV was 2.2 (range: -0.8 to 3.3) and for PH 2.1 (range: 0.8-4.2; P=0.2). The two cohorts were similar with respect to age, BSA, conduit indication, bypass and cross-clamp time. Graft dysfunction is defined as right ventricular outflow tract obstruction with peak echo-Doppler gradient >40mmHg and/or grade III/IV conduit valve regurgitation. Graft failure is defined as need for conduit replacement or need for catheter or surgical re-intervention. Follow-up was greater in number in homografts (BJV, 4.4 ± 3.0 years vs PH, 5.9 ± 3.6 years; P=0.05). Results: Early and late mortality were similar (BJV, 80%; PH 88%; P=0.55). No death was graft related. Freedom from dysfunction was improved at 5 and 10 years with BJV (BJV, 90% at 85% vs PH, 71% and 24% P<0.05). Conduit failure trended higher in the PH cohort at 5 and 10 years (BJV, 85% and 67% vs PH, 75% and 45%; P=0.06). Freedom from explantation was significantly better for BJV patients (BJV, 85% vs PH, 47% P<0.001. Freedom from distal conduit stenosis was similar (BJV, 52% vs PH, 44% P=0.36). Conclusions: This study suggests that the early performance of small BJV may be more advantageous than homografts. A BJV conduit is an appropriate first choice for conduit replacement in patients less than 2 years of age.

Original languageEnglish
Pages (from-to)318-325
Number of pages8
JournalEuropean Journal of Cardio-thoracic Surgery
Volume38
Issue number3
DOIs
StatePublished - Sep 2010

Fingerprint

Jugular Veins
Allografts
Lung
Transplants
Ventricular Outflow Obstruction
Pathologic Constriction
Catheters

Keywords

  • Conduits
  • Outcomes
  • Pulmonary homograft
  • Pulmonary valve replacement

ASJC Scopus subject areas

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

Cite this

Comparison of bovine jugular vein with pulmonary homograft conduits in children less than 2 years of age. / Fiore, Andrew C.; Ruzmetov, Mark; Huynh, Danny; Hanley, Seth; Rodefeld, Mark; Turrentine, Mark; Brown, John.

In: European Journal of Cardio-thoracic Surgery, Vol. 38, No. 3, 09.2010, p. 318-325.

Research output: Contribution to journalArticle

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abstract = "Objectives: The optimal pulmonary valved conduit for infants and small children remains controversial. This report compares the initial insertion outcome of small caliber bovine jugular vein (BJV) (12-14mm) with pulmonary homografts (PHs) (10-15mm) in patients under age 2. Methods: From December 1998 to August 2009, 84 children (mean age 8.4 ± 8.5 months) received BJV (n=51) or PH (n=32) conduits. Mean Z score for BJV was 2.2 (range: -0.8 to 3.3) and for PH 2.1 (range: 0.8-4.2; P=0.2). The two cohorts were similar with respect to age, BSA, conduit indication, bypass and cross-clamp time. Graft dysfunction is defined as right ventricular outflow tract obstruction with peak echo-Doppler gradient >40mmHg and/or grade III/IV conduit valve regurgitation. Graft failure is defined as need for conduit replacement or need for catheter or surgical re-intervention. Follow-up was greater in number in homografts (BJV, 4.4 ± 3.0 years vs PH, 5.9 ± 3.6 years; P=0.05). Results: Early and late mortality were similar (BJV, 80{\%}; PH 88{\%}; P=0.55). No death was graft related. Freedom from dysfunction was improved at 5 and 10 years with BJV (BJV, 90{\%} at 85{\%} vs PH, 71{\%} and 24{\%} P<0.05). Conduit failure trended higher in the PH cohort at 5 and 10 years (BJV, 85{\%} and 67{\%} vs PH, 75{\%} and 45{\%}; P=0.06). Freedom from explantation was significantly better for BJV patients (BJV, 85{\%} vs PH, 47{\%} P<0.001. Freedom from distal conduit stenosis was similar (BJV, 52{\%} vs PH, 44{\%} P=0.36). Conclusions: This study suggests that the early performance of small BJV may be more advantageous than homografts. A BJV conduit is an appropriate first choice for conduit replacement in patients less than 2 years of age.",
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T1 - Comparison of bovine jugular vein with pulmonary homograft conduits in children less than 2 years of age

AU - Fiore, Andrew C.

AU - Ruzmetov, Mark

AU - Huynh, Danny

AU - Hanley, Seth

AU - Rodefeld, Mark

AU - Turrentine, Mark

AU - Brown, John

PY - 2010/9

Y1 - 2010/9

N2 - Objectives: The optimal pulmonary valved conduit for infants and small children remains controversial. This report compares the initial insertion outcome of small caliber bovine jugular vein (BJV) (12-14mm) with pulmonary homografts (PHs) (10-15mm) in patients under age 2. Methods: From December 1998 to August 2009, 84 children (mean age 8.4 ± 8.5 months) received BJV (n=51) or PH (n=32) conduits. Mean Z score for BJV was 2.2 (range: -0.8 to 3.3) and for PH 2.1 (range: 0.8-4.2; P=0.2). The two cohorts were similar with respect to age, BSA, conduit indication, bypass and cross-clamp time. Graft dysfunction is defined as right ventricular outflow tract obstruction with peak echo-Doppler gradient >40mmHg and/or grade III/IV conduit valve regurgitation. Graft failure is defined as need for conduit replacement or need for catheter or surgical re-intervention. Follow-up was greater in number in homografts (BJV, 4.4 ± 3.0 years vs PH, 5.9 ± 3.6 years; P=0.05). Results: Early and late mortality were similar (BJV, 80%; PH 88%; P=0.55). No death was graft related. Freedom from dysfunction was improved at 5 and 10 years with BJV (BJV, 90% at 85% vs PH, 71% and 24% P<0.05). Conduit failure trended higher in the PH cohort at 5 and 10 years (BJV, 85% and 67% vs PH, 75% and 45%; P=0.06). Freedom from explantation was significantly better for BJV patients (BJV, 85% vs PH, 47% P<0.001. Freedom from distal conduit stenosis was similar (BJV, 52% vs PH, 44% P=0.36). Conclusions: This study suggests that the early performance of small BJV may be more advantageous than homografts. A BJV conduit is an appropriate first choice for conduit replacement in patients less than 2 years of age.

AB - Objectives: The optimal pulmonary valved conduit for infants and small children remains controversial. This report compares the initial insertion outcome of small caliber bovine jugular vein (BJV) (12-14mm) with pulmonary homografts (PHs) (10-15mm) in patients under age 2. Methods: From December 1998 to August 2009, 84 children (mean age 8.4 ± 8.5 months) received BJV (n=51) or PH (n=32) conduits. Mean Z score for BJV was 2.2 (range: -0.8 to 3.3) and for PH 2.1 (range: 0.8-4.2; P=0.2). The two cohorts were similar with respect to age, BSA, conduit indication, bypass and cross-clamp time. Graft dysfunction is defined as right ventricular outflow tract obstruction with peak echo-Doppler gradient >40mmHg and/or grade III/IV conduit valve regurgitation. Graft failure is defined as need for conduit replacement or need for catheter or surgical re-intervention. Follow-up was greater in number in homografts (BJV, 4.4 ± 3.0 years vs PH, 5.9 ± 3.6 years; P=0.05). Results: Early and late mortality were similar (BJV, 80%; PH 88%; P=0.55). No death was graft related. Freedom from dysfunction was improved at 5 and 10 years with BJV (BJV, 90% at 85% vs PH, 71% and 24% P<0.05). Conduit failure trended higher in the PH cohort at 5 and 10 years (BJV, 85% and 67% vs PH, 75% and 45%; P=0.06). Freedom from explantation was significantly better for BJV patients (BJV, 85% vs PH, 47% P<0.001. Freedom from distal conduit stenosis was similar (BJV, 52% vs PH, 44% P=0.36). Conclusions: This study suggests that the early performance of small BJV may be more advantageous than homografts. A BJV conduit is an appropriate first choice for conduit replacement in patients less than 2 years of age.

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