Key result
Diepoxy-treated porcine aortic conduits were associated with a 3 times higher risk of reintervention caused by calcification compared to glutaraldehyde-treated bovine jugular veins (P<0.001).
Why the study?
Does the type of xenogeneic material affect the incidence of reintervention and calcification in pediatric patients undergoing right ventricular outflow tract reconstruction?
Cohort (n=301)
No
Does the type of xenogeneic material affect the incidence of reintervention and calcification in pediatric patients undergoing right ventricular outflow tract reconstruction?
While overall reintervention rates did not differ significantly among xenograft types, diepoxy-treated porcine aortic conduits were associated with a significantly higher risk of calcification-related reintervention in pediatric right ventricular outflow tract reconstruction.
Answers are grounded in this paper and cite their sources.
Warrants caution selecting diepoxy-treated porcine conduits for pediatric RVOT reconstruction; leaves open optimal xenograft choice pending prospective trials.
OBJECTIVES: In this study, we aimed to determine the incidence of reintervention and calcification of xenografts in paediatric patients who underwent placement of the right ventricle-to-pulmonary artery valved conduits. METHODS: We retrospectively analysed clinical data of paediatric patients (1 day-18 years) who underwent right ventricular outflow tract reconstruction using xenograft from 2000 to 2016 at a single centre. RESULTS: A total of 301 patients underwent the placement of 337 xenografts, including glutaraldehyde-treated bovine jugular vein (n = 171, 50.7%), glutaraldehyde-treated bovine pericardial valved conduit (n = 75, 22.3%), diepoxy-treated porcine aortic conduit (n = 58, 17.2%) and diepoxy-treated bovine pericardial valved conduit (DE-PVC) (n = 33, 9.8%). There were 284 (84.3%) primary implantations and 53 (15.7%) reimplantations. The median follow-up was 4.2 years (range 1.5 months-14.5 years). The multivariate regression analysis did not reveal statistically significant associations of the first reintervention with the type of xenograft (P = 0.78). At reintervention, calcification of the wall and/or cusps was the main cause of conduit dysfunction in 66.4% of cases. On the basis of the multivariate Cox regression analysis, xenograft types were significant predictors of reintervention caused by conduit calcification (P = 0.012). The diepoxy-treated porcine aortic conduit group had the risk of calcification 3 times higher than the glutaraldehyde-treated bovine jugular vein group (P < 0.001).The glutaraldehyde-treated bovine pericardial valved conduit and diepoxy-treated bovine pericardial valved conduit groups had the risk of calcification comparable with the glutaraldehyde-treated bovine jugular vein group in multivariate proportional hazards model (P = 0.36 and P = 0.59, respectively). CONCLUSIONS: We have not revealed significant difference in the freedom from first reintervention among types of conduit. Calcification leading to the conduit dysfunction was present in all groups; however, diepoxy-treated porcine aortic conduits demonstrated suboptimal results in terms of calcification at follow-up.
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Nichay et al. (2018) conducted a cohort in Right ventricular outflow tract reconstruction (n=301). Diepoxy-treated porcine aortic conduit vs. Glutaraldehyde-treated bovine jugular vein was evaluated on Reintervention caused by conduit calcification (HR 3, p=<0.001). Diepoxy-treated porcine aortic conduits were associated with a 3 times higher risk of reintervention caused by calcification compared to glutaraldehyde-treated bovine jugular veins (P<0.001).
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