111. Comparison of Bovine Jugular Vein Conduit and Polytetrafluoroethylene Valved Conduit for Right Ventricular Outflow Tract Reconstruction: A Propensity Score-Matched Analysis

Objective: This study aimed to compare the clinical outcomes of right ventricular outflow tract (RVOT) reconstruction using bovine jugular vein conduits and polytetrafluoroethylene (PTFE) valved conduits.
Methods: This study included patients who underwent RVOT reconstruction using bovine jugular vein conduits (Group C) and PTFE valved conduits (Group P) between 2013 and 2023. The median follow-up duration was 52.3 months. Conduit dysfunction was defined by either of the following two criteria: significant stenosis (flow velocity ≥ 3.5 m/sec), or significant regurgitation (≥ moderate). Excessive conduit dilation was defined as an increase in conduit diameter by more than 50% of its original size. Propensity score matching was performed using age, body weight, primary diagnosis, McGoon ratio, dual RVOT pathway, and conduit size as covariates. Kaplan-Meier estimates and the log-rank test were used to assess survival rates. Predictors of conduit dilation were determined using the Cox proportional hazards model.
Results: A total of 261 patients were included in the study (172 patients in Group C, 89 patients in Group P). Of these, 100 patients from Group C and 50 patients from Group P were matched using propensity score analysis. In the matched cohort, the median age and body weight at surgery were 9.9 months and 7.5 kg, respectively. The conduit sizes ranged from 12 to 18 mm. No significant differences were observed between Group C and Group P in 5-year overall survival (94.4% vs. 86.5%), conduit explantation-free survival (75.3% vs. 73.8%), or conduit dysfunction-free survival (51.5% vs. 44.3%) (Figure). In patients with smaller conduits (12 and 14 mm), the 5-year conduit stenosis-free survival rate was significantly lower in Group P (38.3% vs. 63.1%, P=0.027). Excessive conduit dilation was observed exclusively in Group C. On multivariable analysis, truncus arteriosus (HR 3.964; 95% CI, 1.553-10.123; P=0.004), the presence of MAPCA (HR 9.310; 95% CI, 3.671-23.611; P<0.001), and conduit size (HR 0.426; 95% CI, 0.289-.0629; P<0.001) were significant predictors of excessive conduit dilation.
Conclusions: The durability of small and medium-sized bovine jugular vein and PTFE valved conduits is comparable in RVOT reconstruction. Smaller PTFE valved conduits are associated with an increased probability of conduit stenosis. Bovine jugular vein conduits carry a risk of excessive dilation in patients with truncus arteriosus, MAPCA, and smaller conduits.

Dong Hee Jang (1), Eun Seok Choi (1), Tae-Jin Yun (1), Chun Soo Park (1), Bo Sang Kwon (1), Dong-Hee Kim (1), (1) Asan Medical Center, Seoul, Korea

Michael Ma

Commentator

Michael Ma, MD is Associate Professor of Cardiothoracic Surgery at Stanford University’s School of Medicine. He serves as Chief for the Division of Pediatric Cardiac Surgery, and Surgical Director for the Complex Biventricular Reconstruction and Pediatric Advanced Cardiac Therapies programs. His clinical practice encompasses all aspects of congenital heart disease, with an emphasis on complex reconstructive procedures for achieving biventricular circulation, rehabilitating pulmonary artery pathologies, and device therapy for end-stage heart failure.

Dr. Ma’s translational research utilizes biomechanical engineering principles to optimize existing treatments and develop new procedures and therapies, through collaborations between the Schools of Medicine and Engineering. His lab focuses on understanding the atrioventricular valve in single and complex biventricular circulations; de novo surgical repair strategies and devices are evaluated in computational, ex vivo, and large animal models.

 

 

 

 

Eun Seok Choi

Abstract Presenter

I am a pediatric cardiac surgeon, a clinical associate professor in division of pediatric cardiac surgery, Asan Medical Center, University of Ulsan college of medicine, Seoul, Republic of Korea. 

 

Specialties: Congenital