Right Ventricular Outflow Tract Reconstruction with Valved Bovine Jugular Vein Patch in Patients with Complex　Congenital Heart Disease_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

JIN Jing , TAO Liang , WU Zhongshi , CHENG Duan , ZENG Xiangjun , ZHOU Hong.

1. Department of Cardiothoracic Surgery， Wuhan Asia Heart Hospital， Wuhan 430022， P. R. China;;
2. Department of Cardiothoracic Surgery， Second Xiangya Hospital of Central South University， Changsha 410011， P. R. China;

Corresponding author：

Keywords：

Bovine jugular vein; 　Reconstruction of right ventricular outflow tract; 　Tetralogy of Fallot; 　Double outlet of right ventricle; 　Pulmonary stenosis

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Objective　To evaluate early results of valved bovine jugular vein patch for reconstruction of the right ventricular outflow tract （RVOT）.?Methods　From May 2009 to March 2010， a total of 60 patients with complex　congenital heart diseases underwent reconstruction of RVOT with valved bovine jugular vein patch in Wuhan Asia Heart Hospital. There were 42 males and 18 females with their mean age of 6.2±8.9 years （ranging from 5 months to 33 years） and mean body weight of 27.5±24.0 kg， and 34 patients were less than 1 year. Preoperative clinical diagnosis included tetralogy of Fallot （n=38） and double outlet of right ventricle with pulmonary stenosis （n=22）. All the patients underwent one-stage surgical repair. Before operation， 4 patients underwent catheter intervention for their major aortopulmonary　collaterals. The diameters of pulmonary arterial ring of all the patients were 2 standard deviation less than normal range， and trans-annular patch was chosen for RVOT reconstruction. All the patients were postoperatively followed up for 18 to 26 months （mean 21.2±4.6 months）.?Results　There was no in-hospital death. And no second surgical intervention was needed for conspicuous RVOT stenosis or pulmonary regurgitation. Three patients needed reintubation for lung edema after extubation as a result of major aortopulmonary collaterals. Four patients underwent reexploration for postoperative bleeding. And all the other patients were discharged uneventfully. Mean cardiopulmonary bypass time was 84.0±22.0 min， and mean aortic cross-clamping time was 42.0±12.0 min. Mean RVOT gradient right after surgery was 18.0±4.5 mm Hg， which was not statistically different from mean RVOT gradient of 19.2±5.4 mm Hg measured by transthoracic echocardiography at their last postoperative follow-up（P＞0.05）. The degree of pulmonary regurgitation right after surgery was trivial in 32 patients（1＋）， mild in 28 patients（2＋）， which were not statistically different from the degree of pulmonary regurgitation at their last postoperative follow-up: trivial in 28 patients （1＋）， mild in 27 patients（2＋）， and moderate in 5 patients（3＋）. Calcification was not observed on the valved bovine jugular vein patch and valve cusp， and the valve cusp motioned well. No thrombosis or endocarditis was observed on the valved bovine jugular vein.?Conclusions　For patients with tetralogy of Fallot or double outlet of right ventricle （DORV） and pulmonary stenosis， valved bovine jugular vein patch is a good choice for trans-annular reconstruction of RVOT. There is no severe postoperative complication related to bovine jugular vein， the RVOT pressure gradient does not increase significantly， and anti-regurgitation result is satisfactory in short-term follow-up. Further follow-up is required to evaluate its long-term outcome.

Citation： JIN Jing,TAO Liang,WU Zhongshi,CHENG Duan,ZENG Xiangjun,ZHOU Hong.. Right Ventricular Outflow Tract Reconstruction with Valved Bovine Jugular Vein Patch in Patients with Complex　Congenital Heart Disease. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2012, 19(5): 534-537. doi: Copy

1.	Jonas RA，主编. 先天性心脏病外科综合治疗学. 北京：北京大学医学出版社， 2009. 286.
2.	Oechslin EN， Harrison DA， Harris L， et al. Reoperation in adults with repair of tetralogy of Fallot： indications and outcomes. J Thorac Cardiovasc Surg， 1999， 118 （2）：245-251.
3.	Roos-Hesselink J， Perlroth MG， McGhie J， et al. Atrial arrhyth-mias in adults after repair of tetralogy of Fallot. Correlations with clinical， exercise， and echocardiographic ?ndings. Circulation， 1995， 91 （8）：2118-2119.
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5.	Eyskens B， Reybrouck T， Bogaert J， et al. Homograft insertion for pulmonary regurgitation after repair of tetralogy of Fallot improves cardiorespiratory exercise performance. Am J Cardiol， 2000， 85（2）：221-225.
6.	Gatzoulis MA， Balaji S，Webber SA， et al. Risk factors for arrhythmia and sudden cardiac death late after repair of tetralogy of Fallot： a multicentre study. Lancet， 2000， 356 （9234）：975-981.
7.	Lu WD， Zhang M， Wu ZS， et al. The performance of photooxidatively crosslinked acellular bovine jugular vein conduits in the reconstruction of connections between pulmonary arteriesand right ventricles. Biomaterials， 2010， 31 （10）：2934-2943.
8.	Ross DN. Homograft replacement of the aortic valve. Lancet， 1962，2 （7254）：487.
9.	Askovich B， Hawkins JA， Sower CT， et al. Right ventricle-to-pulmonary artery conduit longevity： is it related to allograft size? Ann Thorac Surg， 2007， 84 （3）：907-911.
10.	Elkins RC， Knott-Craig CJ， Ward EW， et al. The Ross operation in children： 10-year experience. Ann Thorac Surg， 1998， 65 （2）：496-502.
11.	Wells WJ， Arroyo H， Bremner RM， et al. Homograft conduit failure in infants is not due to somatic outgrowth. J Thorac Cardiovasc Surg， 2002， 124 （1）：88-96.
12.	Schorn K， Yankah AC， Alexi-Meskhishvilli VA， et al. Risk factors for early degeneration of allografts in pulmonary circulation. Eur J Cardiothorac Surg， 1997， 11 （1）：62-69.
13.	Tweddell JS， Pelech AN， Frommelt PC， et al. Factors affecting longevity of homograft valves used in right ventricular outflow tract reconstruction for congenital heart disease. Circulation， 2000， 102 （19）：suppl III130-133.
14.	Forbess JM， Shah AS， St Louis JD， et al. Cryopreserved homografts in the pulmonary position：determinants of durability. Ann Thorac Surg， 2001， 71 （1）：54-60.
15.	Herijgers P， Ozaki S， Verbeken E， et al. Valved jugular vein segments for right ventricular outflow tract reconstruction in young sheep. J Thorac Cardiovasc Surg， 2002， 124 （4）：798-805.
16.	Ichikawa Y， Noishiki Y， Yamamoto K， et al. Use of bovine jugular vein graft with natural valve for right ventricular outflow tract reconstruction： a one-year animal study. J Thorac Cardiovasc Surg， 1997， 114 （2）：224-233.
17.	徐朝军，宋岚，吴忠仕，等. 环氧交联去细胞牛颈静脉带瓣管道的血液相容性实验研究. 中国胸心血管外科临床杂志， 2011， 18　（4）：338-342.
18.	Fiore AC， Brown JW， Turrentine WT， et al. A bovine jugular vein conduit： a ten-year bi-institutional experience. Ann Thorac Surg， 2011， 92 （1）：183-192.
19.	Natasha Prior， Nelson Alphonso， Philip Arnold， et al. Bovine jugular　vein valved conduit： Up to 10 years follow-up. J Thorac Cardiovasc Surg， 2011， 141 （4）：983-987.
20.	Andrew C， Mark Ruzmetov， Danny Huynh， et al. Comparison of bovine jugular vein with pulmonary homograft conduits in children less than 2 years of age. Eur J Cardiothorac Surg， 2010， 38 （3）：318-325.
21.	Breymann T， Blanz U， Wojtalik MA， et al. European Contegra multicentre study： 7-year results after 165 valved bovine jugular vein graft implantations. Thorac Cardiovasc Surg， 2009， 57 （5）：257-269.
22.	Niclauss L， Delay D， Hurni M， et al. Experience and intermediate-term results using the Contegra heterograft for right ventricular outflow reconstruction in adults. Interact Cardiovasc Thorac Surg， 2009， 9 （4）： 667-671.
23.	Palma G， Mannacio VA， Mastrogiovanni G， et al. Bovine valved venous xenograft in pulmonary position： medium term evaluation of risk factors for dysfunction and failure after 156 implants. J　Cardiovasc Surg （Torino）， 2011， 52 （2）：285-291.
24.	Breymann T, Thies WR, Boethig D， et al. Bovine valved venous xenografts for RVOT reconstruction：results after 71 implantations. Eur J Cardiothorac Surg， 2002， 21 （4）：703-710.
25.	Tiete AR， Sachweh JS， Roemer U， et al. Right ventricular out?ow tract reconstruction with the Contegra jugular vein conduit： a word of caution. Ann Thorac Surg， 2004， 77 （6）：2151-2156.
26.	Meyns B， Van Garsse L， Boshoff D， et al. The Contegra conduit in the right ventricular outflow tract induced supravalvular stenosis. J Thorac　Cardiovasc Surg， 2004， 128 （6）：834-840.
27.	Rastan AJ， Walther T， Daehnert I， et al. Bovine jugular vein conduit　for righ ventricularoutflow tract reconstruction： evaluation of risk factors for mid-term outcome. Ann Thorac Surg， 2006， 82 （4）：1308-1315.
28.	Sekarski N， van Meir H， Rijlaarsdam ME， et al. Right ventricular outflow tract reconstruction with the bovine jugular vein graft： 5 years’ experience with 133 Patients. Ann Thorac Surg， 2007， 84 （2）：599-605.
29.	Bajraktari G，Olloni R，Daullxhiu I，et al.MRSA endocarditis of　bovine contegra valved conduit： a case report. Cases J，2009，2 （1）：57.
30.	Christenson JT， Sierra J， Colina Manzano NE， et al. Homografts and xenografts for right ventricular outflow tract reconstruction： long-term results. Ann Thorac Surg， 2010， 90 （4）：1287-1293.

1. 　Jonas RA，主编. 先天性心脏病外科综合治疗学. 北京：北京大学医学出版社， 2009. 286.
2. 　Oechslin EN， Harrison DA， Harris L， et al. Reoperation in adults with repair of tetralogy of Fallot： indications and outcomes. J Thorac Cardiovasc Surg， 1999， 118 （2）：245-251.
3. 　Roos-Hesselink J， Perlroth MG， McGhie J， et al. Atrial arrhyth-mias in adults after repair of tetralogy of Fallot. Correlations with clinical， exercise， and echocardiographic ?ndings. Circulation， 1995， 91 （8）：2118-2119.
4. 　Niezen RA，Helbing WA，van der Wall EE，et al.Biventricular systolic function and mass studied with MR imaging in children with pulmonary regurgitation after repair for tetralogy of Fallot. Radiology， 1996， 201 （1）：135-140.
5. 　Eyskens B， Reybrouck T， Bogaert J， et al. Homograft insertion for pulmonary regurgitation after repair of tetralogy of Fallot improves cardiorespiratory exercise performance. Am J Cardiol， 2000， 85（2）：221-225.
6. 　Gatzoulis MA， Balaji S，Webber SA， et al. Risk factors for arrhythmia and sudden cardiac death late after repair of tetralogy of Fallot： a multicentre study. Lancet， 2000， 356 （9234）：975-981.
7. 　Lu WD， Zhang M， Wu ZS， et al. The performance of photooxidatively crosslinked acellular bovine jugular vein conduits in the reconstruction of connections between pulmonary arteriesand right ventricles. Biomaterials， 2010， 31 （10）：2934-2943.
8. 　Ross DN. Homograft replacement of the aortic valve. Lancet， 1962，2 （7254）：487.
9. 　Askovich B， Hawkins JA， Sower CT， et al. Right ventricle-to-pulmonary artery conduit longevity： is it related to allograft size? Ann Thorac Surg， 2007， 84 （3）：907-911.
10. 　Elkins RC， Knott-Craig CJ， Ward EW， et al. The Ross operation in children： 10-year experience. Ann Thorac Surg， 1998， 65 （2）：496-502.
11. 　Wells WJ， Arroyo H， Bremner RM， et al. Homograft conduit failure in infants is not due to somatic outgrowth. J Thorac Cardiovasc Surg， 2002， 124 （1）：88-96.
12. 　Schorn K， Yankah AC， Alexi-Meskhishvilli VA， et al. Risk factors for early degeneration of allografts in pulmonary circulation. Eur J Cardiothorac Surg， 1997， 11 （1）：62-69.
13. 　Tweddell JS， Pelech AN， Frommelt PC， et al. Factors affecting longevity of homograft valves used in right ventricular outflow tract reconstruction for congenital heart disease. Circulation， 2000， 102 （19）：suppl III130-133.
14. 　Forbess JM， Shah AS， St Louis JD， et al. Cryopreserved homografts in the pulmonary position：determinants of durability. Ann Thorac Surg， 2001， 71 （1）：54-60.
15. 　Herijgers P， Ozaki S， Verbeken E， et al. Valved jugular vein segments for right ventricular outflow tract reconstruction in young sheep. J Thorac Cardiovasc Surg， 2002， 124 （4）：798-805.
16. 　Ichikawa Y， Noishiki Y， Yamamoto K， et al. Use of bovine jugular vein graft with natural valve for right ventricular outflow tract reconstruction： a one-year animal study. J Thorac Cardiovasc Surg， 1997， 114 （2）：224-233.
17. 　徐朝军，宋岚，吴忠仕，等. 环氧交联去细胞牛颈静脉带瓣管道的血液相容性实验研究. 中国胸心血管外科临床杂志， 2011， 18　（4）：338-342.
18. 　Fiore AC， Brown JW， Turrentine WT， et al. A bovine jugular vein conduit： a ten-year bi-institutional experience. Ann Thorac Surg， 2011， 92 （1）：183-192.
19. 　Natasha Prior， Nelson Alphonso， Philip Arnold， et al. Bovine jugular　vein valved conduit： Up to 10 years follow-up. J Thorac Cardiovasc Surg， 2011， 141 （4）：983-987.
20. 　Andrew C， Mark Ruzmetov， Danny Huynh， et al. Comparison of bovine jugular vein with pulmonary homograft conduits in children less than 2 years of age. Eur J Cardiothorac Surg， 2010， 38 （3）：318-325.
21. 　Breymann T， Blanz U， Wojtalik MA， et al. European Contegra multicentre study： 7-year results after 165 valved bovine jugular vein graft implantations. Thorac Cardiovasc Surg， 2009， 57 （5）：257-269.
22. 　Niclauss L， Delay D， Hurni M， et al. Experience and intermediate-term results using the Contegra heterograft for right ventricular outflow reconstruction in adults. Interact Cardiovasc Thorac Surg， 2009， 9 （4）： 667-671.
23. 　Palma G， Mannacio VA， Mastrogiovanni G， et al. Bovine valved venous xenograft in pulmonary position： medium term evaluation of risk factors for dysfunction and failure after 156 implants. J　Cardiovasc Surg （Torino）， 2011， 52 （2）：285-291.
24. 　Breymann T, Thies WR, Boethig D， et al. Bovine valved venous xenografts for RVOT reconstruction：results after 71 implantations. Eur J Cardiothorac Surg， 2002， 21 （4）：703-710.
25. 　Tiete AR， Sachweh JS， Roemer U， et al. Right ventricular out?ow tract reconstruction with the Contegra jugular vein conduit： a word of caution. Ann Thorac Surg， 2004， 77 （6）：2151-2156.
26. 　Meyns B， Van Garsse L， Boshoff D， et al. The Contegra conduit in the right ventricular outflow tract induced supravalvular stenosis. J Thorac　Cardiovasc Surg， 2004， 128 （6）：834-840.
27. 　Rastan AJ， Walther T， Daehnert I， et al. Bovine jugular vein conduit　for righ ventricularoutflow tract reconstruction： evaluation of risk factors for mid-term outcome. Ann Thorac Surg， 2006， 82 （4）：1308-1315.
28. 　Sekarski N， van Meir H， Rijlaarsdam ME， et al. Right ventricular outflow tract reconstruction with the bovine jugular vein graft： 5 years’ experience with 133 Patients. Ann Thorac Surg， 2007， 84 （2）：599-605.
29. 　Bajraktari G，Olloni R，Daullxhiu I，et al.MRSA endocarditis of　bovine contegra valved conduit： a case report. Cases J，2009，2 （1）：57.
30. 　Christenson JT， Sierra J， Colina Manzano NE， et al. Homografts and xenografts for right ventricular outflow tract reconstruction： long-term results. Ann Thorac Surg， 2010， 90 （4）：1287-1293.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Right Ventricular Outflow Tract Reconstruction with Valved Bovine Jugular Vein Patch in Patients with Complex　Congenital Heart Disease

Abstract Full text Figures/Tables Video References Cited by

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Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Right Ventricular Outflow Tract Reconstruction with Valved Bovine Jugular Vein Patch in Patients with Complex Congenital Heart Disease

Abstract Full text Figures/Tables Video References Cited by

Format

Content

Right Ventricular Outflow Tract Reconstruction with Valved Bovine Jugular Vein Patch in Patients with Complex　Congenital Heart Disease