Bovine valved xenograft in pulmonary position: medium-term follow-up with excellent hemodynamics and freedom from calcification

Abstract

Background: This study was designed to evaluate the outcome of Contegra xenograft valved conduit (Contegra, Medtronic Inc, Minneapolis, MN).

Methods: From April 1999 to December 2003, 67 patients with a mean age of 16.1 +/-15.0 years (2 months to 53 years) and a mean weight of 39.7 +/- 27.1 kg (4 to 95 kg) were discharged after implantation of a Contegra conduit. The diagnosis contained the following: pulmonary valve replacement during Ross operation (n = 27), pulmonary valve regurgitation (n = 9), tetralogy of Fallot (n = 7), pulmonary atresia with ventricular septal defect (n = 7), double outlet right ventricle (n = 7), truncus arteriosus (n = 5), Taussig-Bing (n = 2), obstructed conduit (n = 2), and double discordance (n = 1). Conduit size was 14 mm in 2, 16 mm in 7, 18 mm in 12, 20 mm in 13, and 22 mm in 33 patients. Mean cardiopulmonary bypass was 155 +/- 48 min (65 to 337 min) and mean aortic cross clamping was 69 +/- 38 min (0 to 146 min). All patients underwent echocardiography, 23 of 67 (34%) patients had cardiac catheterization, and 23 of 67 (34%) patients had electrocardiograph-gated multislice computer tomography.

Results: In a mean follow-up of 26.4 months (1 to 56 months) there was one late death (1 of 67 patients; 1.5% mortality) unrelated to the conduit. Five patients underwent reoperation; four were nonconduit-related and one was to replace a twisted conduit. Five patients underwent interventional cardiology; three were nonconduit-related and two were to stent a twisted or stenotic conduit. Echocardiography showed absent valve regurgitation in 30 of 67 (45%) patients, trivial in 21 of 67 (31%) patients, mild in 16 of 67 (24%) patients. The transconduit pressure gradient remained stable during follow-up, with peak pressure gradient 17 +/- 11 mm Hg and mean gradient 8 +/- 6 mm Hg. Internal diameters corresponded to 110% +/- 20% of the implanted diameter at level of proximal anastomosis, 112% +/- 18% at valve level, and 110% +/- 14% at distal anastomosis. Calcifications were not found, with the exception of a minimal (2.3 mm) parietal calcification.

Conclusions: The Contegra valved conduit provided excellent morphology and hemodynamics, and freedom from calcification in a medium-term follow-up.