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Right arrow Congenital - acyanotic
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J Thorac Cardiovasc Surg 2003;126:490-497
© 2003 The American Association for Thoracic Surgery

Surgery for congenital heart disease

Use of bovine jugular vein to reconstruct the right ventricular outflow tract: early results

Younes Boudjemline, MDa, Damien Bonnet, MDa,*, Tony Abdel Massih, MDa, Gabriella Agnoletti, MDa, Franck Iserin, MDa, Francis Jaubert, MDb, Daniel Sidi, MDa, Pascal Vouhé, MDc

a Service de Cardiologie Pédiatrique, Hôpital Necker Enfants Malades, Paris, France
b Service d’anatomie et de cytologie pathologiques, Hôpital Necker Enfants Malades, Paris, France
c Service de Chirurgie Cardiaque, Hôpital Necker Enfants Malades, Paris, France

Received for publication May 5, 2002; revisions received July 8, 2002; revisions received August 1, 2002; accepted for publication August 15, 2002.

* Address for reprints: Dr Younes Boudjemline, Service de Cardiologie Pédiatrique, Hôpital Necker Enfants Malades, 149, rue de Sèvres, 75743 Paris Cedex 15, France
younes.boudjemline{at}nck.ap-hop-paris.fr

OBJECTIVE: We evaluate early results of bovine jugular vein conduits in the pulmonary outflow.

METHODS: Between April 2000 and September 2001, 31 conduits were placed in the outflow of the right ventricle. Patients who received a conduit as a staged surgical procedure were excluded (n = 3). Implantation age ranged from 0 to 21 years (median, 3.4 years). Conduit diameter ranged from 12 to 20 mm (median, 14 mm). Transthoracic echocardiography was performed at discharge and 3 months after surgery. Patients with significant pulmonary regurgitation and/or stenosis underwent cardiac catheterization.

RESULTS: Four patients died during the follow-up period. Three deaths were unrelated to the conduit. One death was related to the complete thrombosis of the conduit. At 3 months evaluation, pulmonary valve regurgitation was absent or trivial in 19, mild in 2 and severe in 3 of 24 survivors. Four patients had nonfatal conduit-related complications. A transient thrombus formation within 1 leaflet was noted postoperatively in a patient with a moderate pulmonary regurgitation. Three patients required reoperation 3 to 5.8 months after the implantation for conduit failure (mean, 4.3 months). Cardiac catheterization before replacement revealed an aneurysmal dilation of the conduit below a severe stenosis of the pulmonary bifurcation due to important neointimal proliferation.

CONCLUSIONS: Early failure of bovine jugular vein valved conduits can occur because of exaggerated intimal proliferation or thrombotic process within the conduit. Because of these complications, close echocardiographic follow-up is mandatory during the first weeks after implantation.




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