Risk Factors for Infective Endocarditis in Contegra Grafts Used as Right Ventricle-Pulmonary Artery Conduits: A Retrospective Cohort Study.

OBJECTIVES

Surgically implantable bovine jugular vein grafts (Contegra) are widely used for right ventricular outflow tract (RVOT) reconstruction. However, recent studies have reported a high incidence of infective endocarditis (IE) associated with Contegra. We evaluated clinical features and risk factors for Contegra IE.

METHODS

We retrospectively reviewed the patients who underwent Contegra implantation for RVOT reconstruction between 2016 and 2023.

RESULTS

Of the 206 patients, Contegra was used as the first conduit in 161 patients. Median age and weight at operation were 10.8 months and 8.5 kg, respectively. The median diameter of Contegra was 14 mm. Risk factors for decreased time to IE were assessed using Cox regression. During a median Contegra indwelling duration of 43.0 months, 13 patients (13/206, 6.3%) developed IE, at a median of 27.1 months after implantation. Three-year freedom from IE was 94.4%, and the annualized incidence was 1.8% (1.8 cases per 100 patient-years). Gram-positive cocci (11/13, 84.6%) were the most common pathogens. There was one in-hospital death due to fungal IE. Infected conduits were surgically replaced in 11 patients (11/13, 84.6%), during active infection in 8 and after resolution in 3. Higher postoperative conduit peak flow velocity was the only risk factor for IE (hazard ratio [HR] 4.01 per 1 m/s increase; 95% CI, 1.31-12.27; P = .015). A cutoff of 1.45 m/s predicted IE (sensitivity, 84%; specificity, 51%; area under the curve [AUC], 0.67).

CONCLUSIONS

IE occurred in 6.3% of patients after Contegra implantation. Higher conduit peak velocity with turbulent flow on immediate postoperative echocardiography was associated with an increased IE risk.

IRB APPROVAL DATE: March 24, 2025.

IRB REGISTRATION NUMBER: S2024-2302-0001.