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 pa-tients 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 ≥ 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.