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J Thorac Cardiovasc Surg 2004;127:610
© 2004 The American Association for Thoracic Surgery

Letter to the editor

Early failure of bovine jugular vein conduits

Claudio Zavanella, MD, Francisco Portela, MD

Pediatric Cardiac Surgery Section, Complejo Hospitalario Universitario Juan Canalejo, A Coruña, Spain

To the Editor:

We read with great interest the article by Boudjemline and colleagues1 recently published in The Journal of Thoracic and Cardiovascular Surgery. They describe the early results of the bovine jugular vein conduits placed in the right ventricular outflow tract. The event-free survival curve was less than 70% at only 3 months after surgery. There was 1 late death related to the conduit, 1 episode of thrombus formation that required heparin therapy, and another 3 patients required conduit replacement at a mean interval of 4.3 months after the initial operation. An interesting finding was an aneurysmal dilation of the distal portion of the conduit.

Our experience has been similar to that of the authors. Three patients required conduit replacement at 16, 18, and 25 months after the initial operation. All patients had a significant gradient between the right ventricle and the pulmonary artery branches, mainly the left main pulmonary branch; an aneurysmal dilation of the distal conduit occurred in 2 patients and varying degrees of pulmonary insufficiency occurred in all. Conduit diameters were 12 mm in 2 patients and 14 mm in the other patient. All patients were on antiaggregant therapy, which is our standard management protocol for grafts.

Findings at surgery were disappearance of the conduit valve, presence of a huge aneurysmal dilation of the conduit in 2 cases, and extensive fibrosis at the conduit-pulmonary artery anastomotic line in all. This particular finding is of extreme importance, since our patients, as well as 2 patients in Boudjemline's article, have persistent residual pulmonary artery stenosis, despite extensive reconstruction during conduit replacement.

The bovine jugular vein conduit promised to be the conduit of choice for use in neonates and infants due to its excellent handling properties, but these early and midterm complications should raise a note of caution on its use.


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 References
 

  1. Boudjemline Y, Bonnet D, Massih TA, Agnoletti G, Iserin F, Jaubert F, et al. Use of bovine jugular vein to reconstruct the right ventricular outflow tract: early results. J Thorac Cardiovasc Surg. 2003;126:490–497[Abstract/Free Full Text]



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 Ann. Thorac. Surg.Home page
J. W. Brown, M. Ruzmetov, M. D. Rodefeld, P. Vijay, and R. K. Darragh
Valved bovine jugular vein conduits for right ventricular outflow tract reconstruction in children: an attractive alternative to pulmonary homograft.
Ann. Thorac. Surg., September 1, 2006; 82(3): 909 - 916.
[Abstract] [Full Text] [PDF]

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