Mid-term outcomes following valved bovine jugular vein conduit versus autologous pericardium conduit for right ventricular outflow tract reconstruction / 第二军医大学学报

ABSTRACT

Objective To compare the mid-term outcomes of valved bovine jugular vein conduit and autologous pericardium conduit in reconstruction of right ventricular outflow tract. Methods Eighteen congenital heart disease patients were implanted with external conduits (included 11 valved bovine jugular vein conduits and 7 autologous pericardium conduits) for right ventricular outflow tract reconstruction between May 2013 and Jul. 2016. There were 11 males and 7 females at age of 2-16 (5.22±4.12) years. Preoperative clinical diagnoses included pulmonary artery atresia with ventricular septal defect (n＝7), double outlet of right ventricle with pulmonary stenosis (n＝4), persistent truncus arteriosus (n＝3), persistent truncus arteriosus with absence of right pulmonary artery (n＝1), corrected transposition of great arteries with pulmonary stenosis (n＝1), and transposition of great arteries with pulmonary stenosis (n＝2). The perioperative status was recorded. The cardiac ultrasound and computed tomography angiography (CTA) were used to evaluate the efficacy during 4-56 months of follow-up. Results There were no perioperative deaths in the bovine jugular vein conduit group, and 2 deaths in the autologous pericardium conduit group. One died of pulmonary hypertension crisis and the other died of low cardiac output syndrome. The ratio of right ventricular pressure to radial arterial pressure, duration of mechanical ventilation and intensive care unit (ICU) stay after surgery were significantly lower in the bovine jugular vein conduit group than those in the autologous pericardium conduit group (all P0.05). There were no significant differences in extracorporeal circulation time, aortic cross-clamping time, transvalvular gradient in right ventricular outflow tract, blood consumption or total hospitalization costs between the two groups (all P0.05). During follow-up, there were no deaths in the two groups, no reoperations in the bovine jugular vein conduit group, and 1 case received reoperation 2 years after surgery due to severe right ventricular dysfunction in the autologous pericardium conduit group. In the bovine jugular vein conduit group, the transvalvular gradients in right ventricular outflow tract at the last follow-up and before discharge were (22.91±7.31) mmHg (1 mmHg＝0.133 kPa) and (20.45±6.70) mmHg, respectively, and the difference was not significant (P0.05). In the autologous pericardium conduit group, the transvalvular gradient in right ventricular outflow tract was (29.20±18.09) mmHg at the last follow-up and (16.14±4.02) mmHg before discharge, and the difference was significant (P0.05). At the last follow-up after surgery, there were 8 cases of mild reflux and 3 cases of moderate reflux in the bovine jugular vein conduit group, and 1 case of mild reflux, 2 cases of moderate reflux and 2 cases of severe reflux in the autologous pericardium conduit group, and the difference between the two groups was significant (P0.05). Postoperative ultrasonography showed the thickened valve leaflets with good valve movement in the bovine jugular vein conduit. No calcification, thrombosis and infective endocarditis were found in the two groups. Postoperative cardiac CTA found that there was aneurysmal dilatation in 1 middle segment and 1 proximal anastomotic stoma of the bovine jugular vein conduit group, and no dilatation in the autologous pericardium conduit group. Conclusion Domestic valved bovine jugular vein conduit is suitable for right ventricular outflow tract reconstruction in patients with complex congenital heart malformations. Mid-term follow-up shows that bovine jugular vein conduit has good anti-reflux performance and no severe obstruction or calcification. It is obviously superior to autologous pericardium conduit. However, some bovine jugular vein conduits have aneurysmal dilatation in mid-term follow-up, which needs to be further improved.