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Ann Thorac Surg 2007;84:599-605
© 2007 The Society of Thoracic Surgeons

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Original Articles: Cardiovascular

Right Ventricular Outflow Tract Reconstruction With the Bovine Jugular Vein Graft: 5 Years’ Experience With 133 Patients

^a Pediatric Cardiology Unit, Department of Cardiac Surgery, Centre Hospitalier Universitaire Vaudoise, Lausanne, Switzerland
^b Department of Cardiac Surgery and Pediatric Cardiology, Leiden University Medical Center, Leiden
^c Department of Pediatric Cardiology, VU Medical Center, Amsterdam, the Netherlands

Accepted for publication April 5, 2007.

^_* Address correspondence to Dr Hazekamp, Kinderhartcentrum D6-26, Leiden University Medical Center, PO Box 9600, Leiden, 2300 RC, the Netherlands (Email: m.g.hazekamp{at}lumc.nl).

Presented at the Poster Session of the Forty-third Annual Meeting of The Society of Thoracic Surgeons, San Diego, CA, Jan 29–31, 2007.

Background: We analyzed the results in two centers of using bovine jugular vein graft for right ventricular outflow tract reconstruction.

Methods: From April 1999 to July 2005, 133 children with a median age of 30.9 months (range, 4 days to 19 years) underwent graft implantation. Echocardiography was performed during follow-up and retrospectively reviewed.

Results: Nongraft-related early mortality occurred in 8 patients. Late mortality occurred in 11 patients, 2 late deaths were graft related (endocarditis). Median follow-up was 31.6 months (range, 1 to 73). Twelve patients received a new graft, because of endocarditis (3), distal pulmonary artery branch stenosis (4), graft obstruction caused by fibrosis (4), or thrombosis (1). Echocardiography Doppler studies showed good conduit function, with 92% of the patients having absent, trivial, or only mild valve regurgitation at last follow-up. A moderate degree of conduit stenosis due to external compression was observed in 2 patients. Twenty-five patients with otherwise intact conduits had hemodynamically significant distal stenosis. In most cases, the pulmonary branch stenosis was related to preoperative small pulmonary arteries and young age at operation. At 31.6 months, significant graft dilatation was observed in 4 grafts and was related to pulmonary artery branch obstruction or pulmonary hypertension. Calcification did not occur in 5 years time. Survival was 85.7%, freedom from conduit explantation was 91%, and freedom from intervention for pulmonary artery branch stenosis was 80% after 5 years.

Conclusions: The bovine jugular vein graft is a valuable right ventricular outflow tract conduit, but younger age and small pulmonary arteries increase the risk of distal conduit stenosis.