Bovine valved xenograft (Contegra) conduit in the extracardiac fontan procedure: The preliminary experience

Objective: Constructing a competent valve using the xenograft valved conduit (Contegra) in the extracardiac Fontan connection may maintain better forward flow into the pulmonary circulation. The preliminary results and potential advantages of using the Contegra are discussed in this review. Method: A retrospective review of 18 patients who underwent the extracardiac Fontan connection using the Contegra conduit from June 2002 to September 2005. Results: Median age at the time of operation was 4.5 year (range 2.5-34 years). In 15 patients (83%) a 4 mm fenestration was created. Overall operative mortality was 11 % (two patients); one patient died because of arrhythmia & sepsis, and the other one due to thrombosed Fontan connection. The ranges of intensive care unit stay, chest tube duration, and hospital stay were 1-18 days (median, 2 days), 4-38 days (median, 7 days), and 5-47 days (median, 12.5 days), respectively. Follow-up is available for 15 (94%) patients at a mean of 15.8 months (range 8-48 months) postoperatively. They were all asymptomatic and their room air oxygen saturation ranged between 88% and 100% (mean, 96.1%). There have been no further thromboembolic episodes during follow up. Echocardiograms demonstrated patent conduit in all patients with no hepatic vein reversal flow except to a minimal degree in five patients; however the valve competency was demonstrated radiologically. Conclusions: The Contegra xenograft is a potential alternative conduit for the extracardiac Fontan connections. These encouraging preliminary results may support better pulmonary forward flow.