Background: The optimal pulmonary valved conduit for infants and small children remains controversial. This report compares the initial insertion outcome of small caliber Contegra (12-14mm) with pulmonary homografts (10-15mm) in patients under age 2.
Methods: From December 1998 to December 2008, 79 children (mean age 8.4 + 8.5 mo) received Contegra (n=48) or homograft (n=31) conduits. Mean Z-score for Contegra was 2.2 (range, -0.8-3.3) and for homograft 2.1 (range, 0.8-4.2; P=0.2). The two cohorts were similar with respect to age, BSA, conduit indication, bypass and cross clamp time. Graft dysfunction is defined as right ventricular outflow tract obstruction with peak echo-Doppler gradient >40 mm Hg and/or grade III/IV conduit valve regurgitation. Graft failure is defined as need for conduit replacement or need for catheter or surgical reintervention. Follow up was greater in homografts (Contegra, 4.0+2.6yrs vs. homograft, 5.3+2.9yrs; P=0.05).
Results: These data demonstrate conduit dysfunction and the need for explantation were worse for small homografts albeit at longer follow-up interval. Small Contegra conduits trended to have less overall conduit failure. Distal stenosis and actuarial survival were similar in both cohorts. (*Values expressed as percent actuarial freedom from).
Conclusions: This study suggests the early performance of small Contegras may be more advantageous than homografts. A Contegra conduit is an appropriate first choice for conduit replacement in patients less than two years of age.