Department of Cardiac Surgery, University Hospital Gasthuisberg, Leuven, Belgium.
Eur J Cardiothorac Surg. 2011 Sep;40(3):603-9. doi: 10.1016/j.ejcts.2010.11.081. Epub 2011 Feb 19.
A large spectrum of congenital heart diseases requires valved conduits to establish an anatomical continuity between the right ventricle outflow tract (RVOT) and the pulmonary artery. The aim of the present study was to compare the incidence of graft replacement in patients receiving the Contegra conduit (bovine jugular vein graft) with that in patients receiving a homograft implanted in the RVOT.
We reviewed a total of 347 conduits (Contegra 54; homografts 293) implanted in the RVOT from 1989 to 2003 in 323 patients (median age 12.7 years, range 4 days-69 years). Indications were Tetralogy of Fallot (n = 148), Ross operation (n = 89), truncus arteriosus communis (n = 47), pulmonary valve atresia (n = 30), double-outlet right ventricle (n = 15), transposition of the great arteries (n = 12), and endocarditis (n = 6). Follow-up was 99.4% complete (mean time: 5.9 years; range: 0-14.2 years).
Freedom from graft replacement at 1, 5, and 10 years of follow-up in the Contegra and homograft groups were 98.1 ± 1.9%, 78.3 ± 5.8%, and 63.5 ± 7.2% and 99.6 ± 0.4%, 94.0 ± 1.6%, and 81.4 ± 3.4%, respectively (log-rank test, p < 0.001). Independent predictors of graft replacement of the whole sample population were: graft size ≤ 20 mm (hazard ratio (HR) 3.6), age ≤ 10.4 years (HR 3.0), the non-anatomical position of the graft (HR 2.9), and the use of the Contegra conduit (HR 2.5). The multivariable analysis carried out on the propensity-score-matched population confirmed three independent predictors of graft replacement: graft size ≤ 20 mm (HR 8.0), the non-anatomical position of the graft (HR 2.3), and the use of the Contegra conduit (HR 3.7).
Besides size of the graft, age of the patients, and the non-anatomical position of the graft, the use of the Contegra conduit was found to be an independent risk factor for graft replacement in the RVOT. Patients receiving this conduit were more than twice as likely to undergo re-operation for graft replacement as those receiving a homograft.
大量先天性心脏病需要带瓣管道来建立右心室流出道（RVOT）和肺动脉之间的解剖连续性。本研究的目的是比较接受康特格拉管道（牛颈静脉移植物）和接受同种异体移植物植入 RVOT 的患者的移植物置换发生率。
我们回顾了 1989 年至 2003 年期间在 323 例患者（中位年龄 12.7 岁，范围 4 天至 69 岁）中植入的 347 个管道（康特格拉 54 个；同种异体移植物 293 个）。适应证为法洛四联症（n=148）、罗斯手术（n=89）、共同动脉干（n=47）、肺动脉瓣闭锁（n=30）、双出口右心室（n=15）、大动脉转位（n=12）和心内膜炎（n=6）。随访率为 99.4%（平均时间：5.9 年；范围：0-14.2 年）。
康特格拉组和同种异体移植物组的 1、5 和 10 年无移植物置换率分别为 98.1±1.9%、78.3±5.8%和 63.5±7.2%和 99.6±0.4%、94.0±1.6%和 81.4±3.4%（对数秩检验，p<0.001）。全样本人群移植物置换的独立预测因素为：移植物大小≤20mm（风险比（HR）3.6）、年龄≤10.4 岁（HR3.0）、移植物位置非解剖性（HR2.9）和使用康特格拉导管（HR2.5）。对倾向评分匹配人群进行的多变量分析证实了移植物置换的三个独立预测因素：移植物大小≤20mm（HR8.0）、移植物位置非解剖性（HR2.3）和使用康特格拉导管（HR3.7）。
除移植物大小、患者年龄和移植物位置非解剖性外，使用康特格拉导管也是 RVOT 移植物置换的独立危险因素。接受这种导管的患者因移植物置换而再次手术的可能性是接受同种异体移植物的两倍多。
