The Contegra conduit in the right ventricular outflow tract is an independent risk factor for graft replacement.

OBJECTIVE

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.

METHODS

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).

RESULTS

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).

CONCLUSIONS

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.