Bovine Jugular Veins in the Pulmonary Position in Adults – 5 Years' Experience with 64 Implantations

OBJECTIVE: The midterm durability of bovine jugular veins (BJV) in children is comparable to that of homografts. We present the results of 64 bovine jugular vein implantations in adults in a pulmonary position. METHODS: Between August 2003 and July 2008, 60 patients (aged 18 to 65 years) received 64 BJVs. 97 % of them had had previous reconstructions of the right ventricular outflow tract. Diagnoses for treatment included tetralogy of Fallot (n = 49 patients), other congenital malformations (n = 14), and Ross operation (n = 1). Four bovine jugular veins had a diameter of 20 mm, the others had a diameter of 22 mm. RESULTS: Survival after 5 years was 98.4 +/- 1.6 %. Freedom from endocarditis: 84.8 +/- 8.0 % (4 patients required explantation for endocarditis); freedom from explantation for structural valve degeneration: 96.2 +/- 2.6 % (2 patients required explantation); freedom from intervention: 93.2 +/- 2.8 % (3 patients required intervention); moderate insufficiency: 62.9 +/- 15.1 % (8 patients); gradient > or = 50 mmHg: 79.6 +/- 7.4 % (7 patients); degeneration: 56.4 +/- 12.9 % (11); any adverse event: 43.1 +/- 12.8 % (15 patients); calcification or aneurysmal dilatation: 100 %. At any postoperative interval, more than 75 % of the BJVs had neither been explanted nor were they degenerated. CONCLUSION: The BJV might be a promising alternative to homografts, also in adults. Strict antibiotic prophylaxis is mandatory. A prospective randomized multicenter comparison of homografts and BJVs would help to identify the preferable conduit.