High incidence of late infective endocarditis in bovine jugular vein valved conduits

J Thorac Cardiovasc Surg. 2018 Aug;156(2):728-734.e2. doi: 10.1016/j.jtcvs.2018.03.156. Epub 2018 Apr 13.

Abstract

Background: Bovine jugular vein (BJV) grafts (Medtronic, Inc, Minneapolis, Minn) are used to restore right ventricle-to-pulmonary artery continuity. Recent studies have associated these grafts with the development of infective endocarditis. The purpose of this study was to report the incidence of endocarditis in BJV grafts.

Methods: All BJV grafts placed in the right ventricle-to-pulmonary artery position between 2001 and 2017 at our institution were included. Freedom from endocarditis was analyzed using the Kaplan-Meier method and parametric survival regression models.

Results: Overall, 228 patients underwent placement of 253 BJV grafts. The median duration of conduit follow-up was 6 years (5 months to 14 years). Twenty-five conduits developed endocarditis, yielding an incidence of 10% at a median of 7.5 years after surgery. Median duration of symptoms before the diagnosis of endocarditis was 21 days (3-180 days). The most common infectious agents were viridans streptococci (n = 13; 52%). Freedom from endocarditis at 5 and 10 years was 97% and 77%, respectively. After controlling for confounders, BJV grafts had a higher incidence of endocarditis compared with homografts (P < .001). Twenty-three (92%) of the conduits that developed endocarditis were managed surgically, with no mortality.

Conclusions: The incidence of late endocarditis affecting BJV is high. Increased surveillance and a high index of suspicion for endocarditis are warranted in patients who have undergone implantation of BJV grafts, especially if the graft has been in place for more than 7 years. When infective endocarditis has been diagnosed in these grafts, surgical replacement is recommended, with excellent outcomes.

Keywords: Contegra; bovine jugular vein; conduit, endocarditis; right ventricular outflow tract.

MeSH terms

  • Adolescent
  • Adult
  • Animals
  • Bioprosthesis / adverse effects*
  • Bioprosthesis / statistics & numerical data
  • Cattle
  • Child
  • Child, Preschool
  • Endocarditis, Bacterial* / epidemiology
  • Endocarditis, Bacterial* / etiology
  • Female
  • Heart Valve Prosthesis / adverse effects*
  • Heart Valve Prosthesis / statistics & numerical data
  • Heart Valve Prosthesis Implantation* / adverse effects
  • Heart Valve Prosthesis Implantation* / instrumentation
  • Heart Valve Prosthesis Implantation* / statistics & numerical data
  • Humans
  • Infant
  • Infant, Newborn
  • Jugular Veins / transplantation*
  • Male
  • Middle Aged
  • Prosthesis Design
  • Reoperation / statistics & numerical data
  • Retrospective Studies
  • Treatment Outcome
  • Young Adult