Dong-Hee Kim, Young Kern Kwon, Eun Seok Choi, Bo Sang Kwon, Chun Soo Park, Tae-Jin Yun
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During the median follow-up duration of 25.1 months, there were 7 deaths, 34 significant RVOT lesions, 10 endocarditis episodes and 15 explantations. Overall survival and explantation-free survival at 3 years were 94.8% and 78.4%, respectively. Significant RVOT lesions (n = 34) comprised 20 stenoses, 8 regurgitations and 6 combined lesions. Freedom from significant RVOT lesions at 3 years was 62.6%. Cox regression identified higher indexed Contegra size (Contegra diameter/body weight, mm/kg) as the only risk factor for decreased time to explantation or death (hazard ratio 2.32, P < 0.001) and time to significant RVOT lesions development (hazard ratio 2.75, P < 0.001). The cut-off value of indexed Contegra size for significant RVOT lesions at 12 months was 1.905 mm/kg (sensitivity, 0.75; specificity, 0.78; area under the curve, 0.82).</p><p><strong>Conclusions: </strong>Outcomes of RVOT reconstruction using Contegra were acceptable. However, oversized Contegra should be avoided when possible.</p><p><strong>Irb approval date: </strong>26 October 2020.</p><p><strong>Irb registration number: </strong>S2020-2505-0001.</p>","PeriodicalId":13621,"journal":{"name":"Interactive cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":2.1000,"publicationDate":"2022-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9514799/pdf/","citationCount":"2","resultStr":"{\"title\":\"Risk factors for early adverse outcomes after bovine jugular vein conduit implantation: influence of oversized conduit on the outcomes.\",\"authors\":\"Dong-Hee Kim, Young Kern Kwon, Eun Seok Choi, Bo Sang Kwon, Chun Soo Park, Tae-Jin Yun\",\"doi\":\"10.1093/icvts/ivac197\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objectives: </strong>We investigated potential risk factors for early failure of bovine jugular vein conduit (Contegra®) implantation for right ventricular outflow tract (RVOT) reconstruction.</p><p><strong>Methods: </strong>A single-centre retrospective review of 115 consecutive patients (54 males) who underwent RVOT reconstruction with Contegra between 2016 and 2019 was performed. Overall survival, explantation-free survival and freedom from significant RVOT lesions (valve regurgitation ≥ moderate or flow velocity ≥3.5 m/s) were investigated.</p><p><strong>Results: </strong>Median age, body weight and Contegra diameter were 10.3 months [interquartile range (IQR) 5.7-26.9 months], 7.8 kg (IQR 6.3-12.4 kg) and 14 mm (IQR 12-16 mm), respectively. During the median follow-up duration of 25.1 months, there were 7 deaths, 34 significant RVOT lesions, 10 endocarditis episodes and 15 explantations. Overall survival and explantation-free survival at 3 years were 94.8% and 78.4%, respectively. Significant RVOT lesions (n = 34) comprised 20 stenoses, 8 regurgitations and 6 combined lesions. Freedom from significant RVOT lesions at 3 years was 62.6%. Cox regression identified higher indexed Contegra size (Contegra diameter/body weight, mm/kg) as the only risk factor for decreased time to explantation or death (hazard ratio 2.32, P < 0.001) and time to significant RVOT lesions development (hazard ratio 2.75, P < 0.001). The cut-off value of indexed Contegra size for significant RVOT lesions at 12 months was 1.905 mm/kg (sensitivity, 0.75; specificity, 0.78; area under the curve, 0.82).</p><p><strong>Conclusions: </strong>Outcomes of RVOT reconstruction using Contegra were acceptable. 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引用次数: 2
摘要
目的:探讨牛颈静脉导管(Contegra®)植入术重建右心室流出道(RVOT)早期失败的潜在危险因素。方法:对2016年至2019年间连续使用Contegra进行RVOT重建的115例患者(男性54例)进行单中心回顾性分析。研究了总生存率、无原因生存率和无显著RVOT病变(瓣膜返流≥中等或流速≥3.5 m/s)。结果:中位年龄为10.3个月[四分位间距(IQR) 5.7 ~ 26.9个月],体重为7.8 kg (IQR 6.3 ~ 12.4 kg), Contegra直径为14 mm (IQR 12 ~ 16 mm)。在25.1个月的中位随访期间,有7例死亡,34例显著RVOT病变,10例心内膜炎发作,15例解释。3年总生存率和无解释生存率分别为94.8%和78.4%。显著RVOT病变(n = 34)包括狭窄病变20例,反流病变8例,合并病变6例。3年无显著RVOT病变的比例为62.6%。Cox回归发现,高指数Contegra大小(Contegra直径/体重,mm/kg)是缩短移植时间或死亡的唯一危险因素(风险比2.32,P)。结论:使用Contegra重建RVOT的结果是可以接受的。但是,应该尽可能避免过大的Contegra。Irb批准日期:2020年10月26日。Irb注册号:S2020-2505-0001。
Risk factors for early adverse outcomes after bovine jugular vein conduit implantation: influence of oversized conduit on the outcomes.
Objectives: We investigated potential risk factors for early failure of bovine jugular vein conduit (Contegra®) implantation for right ventricular outflow tract (RVOT) reconstruction.
Methods: A single-centre retrospective review of 115 consecutive patients (54 males) who underwent RVOT reconstruction with Contegra between 2016 and 2019 was performed. Overall survival, explantation-free survival and freedom from significant RVOT lesions (valve regurgitation ≥ moderate or flow velocity ≥3.5 m/s) were investigated.
Results: Median age, body weight and Contegra diameter were 10.3 months [interquartile range (IQR) 5.7-26.9 months], 7.8 kg (IQR 6.3-12.4 kg) and 14 mm (IQR 12-16 mm), respectively. During the median follow-up duration of 25.1 months, there were 7 deaths, 34 significant RVOT lesions, 10 endocarditis episodes and 15 explantations. Overall survival and explantation-free survival at 3 years were 94.8% and 78.4%, respectively. Significant RVOT lesions (n = 34) comprised 20 stenoses, 8 regurgitations and 6 combined lesions. Freedom from significant RVOT lesions at 3 years was 62.6%. Cox regression identified higher indexed Contegra size (Contegra diameter/body weight, mm/kg) as the only risk factor for decreased time to explantation or death (hazard ratio 2.32, P < 0.001) and time to significant RVOT lesions development (hazard ratio 2.75, P < 0.001). The cut-off value of indexed Contegra size for significant RVOT lesions at 12 months was 1.905 mm/kg (sensitivity, 0.75; specificity, 0.78; area under the curve, 0.82).
Conclusions: Outcomes of RVOT reconstruction using Contegra were acceptable. However, oversized Contegra should be avoided when possible.
期刊介绍:
Interactive CardioVascular and Thoracic Surgery (ICVTS) publishes scientific contributions in the field of cardiovascular and thoracic surgery, covering all aspects of surgery of the heart, vessels and the chest. The journal publishes a range of article types including: Best Evidence Topics; Brief Communications; Case Reports; Original Articles; State-of-the-Art; Work in Progress Report.