We sought to evaluate the incidence and nature of pulmonary stenosis after imp lantation of the bovine jugular vein graft(Contegra; Medtronic, Inc, Minneapolis , Minn) in the right ventricular outflow tract. Between May 2000 and September 2 002, 58 Contegra conduits(8-22 mm) were implanted during primary(n=27) or redo operations (n=31) in 57 patients, with ages ranging from 2 days to 48 years(mean , 9 years). Indications were truncus arteriosus(n=16), tetralogy of Fallot(n=28) , pulmonary replacement in the Ross operation(n=10), and Rastelli-type repair f or double-outlet right ventricle(n=4). Echocardiography was prospectively perfo rmed by a fixed team of investigators during follow-up(mean, 22.7±10 months). A peak gradient of greater than 50 mm Hg was considered severe stenosis. Two pat ients died from Staphylococcus aureus-induced septicemia and enterococcal endoc arditis after 12 days and 12 weeks, respectively. One patient died of heart fail ure caused by endocardial fibroelastosis after 1 year. Freedom from severe steno sis at the distal anastomosis was 91%±. 3%at 3 months, 68%±6%at 12 months, and 49%±8%at 24 months. The risk of development of stenosis does not change over time. Younger age and its derivatives(graft sizeand indication) are signifi cantly related to the occurrence of severe stenosis(P< . 0001). Seventeen(29%) conduits required an endovascular intervention(balloon dilatation or stent). Sev en(12%) conduits were explanted(endocarditis, 2; stenosis, 5). Histologic analy sis of the explanted conduits showed excessive proliferation of neointima at the level of the distal anastomosis. Valve regurgitation was observed in 9(16%) co nduits and was always secondary to dilatation in the presence of severe distal s tenosis. The Contegra conduit induces a neointimal proliferation at the level of the pulmonary anastomosis. This leads to a high incidence of severe stenosis at intermediate-term follow-up. Copyright.
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