Key result
In patients <20 years, pulmonary homografts had higher 10-year freedom from reintervention compared to bovine jugular vein conduits and aortic homografts.
Why the study?
The study was conducted to compare the performance of homografts and bovine jugular vein conduits in the pulmonary position.
Do pulmonary homografts reduce reintervention, structural valve degeneration, and infective endocarditis compared to bovine jugular vein conduits in patients <20 years of age undergoing pulmonary valve replacement?
Cohort (n=674)
Yes
Do pulmonary homografts reduce reintervention, structural valve degeneration, and infective endocarditis compared to bovine jugular vein conduits in patients <20 years of age undergoing pulmonary valve replacement?
In patients under 20 years of age requiring pulmonary valve replacement with conduits >15 mm, pulmonary homografts significantly outperform bovine jugular vein conduits and aortic homografts in freedom from reintervention and structural valve degeneration.
Answers are grounded in this paper and cite their sources.
Pulmonary homografts may offer better durability than BJV conduits for larger sizes in patients <20 years; leaves open need for prospective trials before practice change.
OBJECTIVE: To compare the performance of homografts and bovine jugular vein (BJV) conduits in the pulmonary position. METHODS: All patients with congenital heart disease up to age 20 years who underwent pulmonary valve replacement with homografts or BJV at 3 centers in Australia were evaluated. There were 674 conduits, with 305 (45%) pulmonary homografts (PHs), 303 (45%) BJV conduits, and 66 (10%) aortic homografts (AHs). Endpoints were freedom from reintervention, structural valve degeneration (SVD), and infective endocarditis (IE). Propensity score matching was used to balance the comparison of PH and BJV conduits. RESULTS: The median follow-up was 6.4 years (interquartile range, IQR, 3.1-10.7 years). Freedom from reintervention at 5 and 10 years was 92% and 80%, respectively, for PH, 74% and 37% for BJV, and 75% and 47% for AH. BJV conduits had a higher risk of reintervention (P < .001) and SVD (P < .001) compared with PHs. These findings were confirmed with propensity score matching valid for conduit size >15 mm. AHs >15 mm had a higher risk of reintervention (P < .001) and SVD (P < .001) compared with PHs >15 mm. The performance of AHs and BJV conduits was similar across all sizes (reintervention, P = .94; SVD, P = .72). The incidence of IE was 1% for PH, 10% for BJV, and 1.5% for AH. CONCLUSIONS: In patients age <20 years with a conduit >15 mm, PHs outperformed BJV conduits and AHs in the pulmonary position. The performance of AH and BJV was comparable. Small conduits (≤15 mm) had similar performance across all conduit types.
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Marathe et al. (2021) conducted a cohort in Congenital heart disease (n=674). Pulmonary homografts vs. Bovine jugular vein conduits and aortic homografts was evaluated on Freedom from reintervention at 10 years (p=<.001). In patients <20 years, pulmonary homografts had higher 10-year freedom from reintervention compared to bovine jugular vein conduits and aortic homografts.
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