Comparison of bovine jugular vein with pulmonary homograft conduits in children less than 2 years of age

Objectives: The optimal pulmonary valved conduit for infants and small children remains controversial. This report compares the initial insertion outcome of small caliber bovine jugular vein (BJV) (12-14 mm) with pulmonary homografts (PHs) (10-15 mm) in patients under age 2. Methods: From December 1998 to August 2009, 84 children (mean age 8.4 +/- 8.5 months) received BJV (n = 51) or PH (n = 32) conduits. Mean Z score for BJV was 2.2 (range: -0.8 to 3.3) and for PH 2.1 (range: 0.8-4.2; P = 0.2). The two cohorts were similar with respect to age, BSA, conduit indication, bypass and cross-clamp time. Graft dysfunction is defined as right ventricular outflow tract obstruction with peak echo-Doppler gradient >40 mmHg and/or grade III/IV conduit valve regurgitation. Graft failure is defined as need for conduit replacement or need for catheter or surgical re-intervention. Follow-up was greater in number in homografts (BJV, 4.4 +/- 3.0 years vs PH, 5.9 +/- 3.6 years; P = 0.05). Results: Early and late mortality were similar (BJV, 80%; PH 88%; P = 0.55). No death was graft related. Freedom from dysfunction was improved at 5 and 10 years with BJV (BJV, 90% at 85% vs PH, 71% and 24% P < 0.05). Conduit failure trended higher in the PH cohort at 5 and 10 years (BJV, 85% and 67% vs PH, 75% and 45%; P = 0.06). Freedom from explantation was significantly better for BJV patients (BJV, 85% vs PH, 47% P < 0.001. Freedom from distal conduit stenosis was similar (BJV, 52% vs PH, 44% P = 0.36). Conclusions: This study suggests that the early performance of small BJV may be more advantageous than homografts. A BJV conduit is an appropriate first choice for conduit replacement in patients less than 2 years of age. (C) 2010 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.