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

Ziv Beckerman, Luis E. De León, Rodrigo Zea-Vera, Carlos Mery, Charles Fraser

Research output: Contribution to journalArticle

10 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)728-734.e2
JournalJournal of Thoracic and Cardiovascular Surgery
Volume156
Issue number2
DOIs
StatePublished - Aug 1 2018

Fingerprint

Jugular Veins
Endocarditis
Incidence
Transplants
Pulmonary Artery
Heart Ventricles
Viridans Streptococci
Allografts

Keywords

  • Contegra
  • bovine jugular vein
  • conduit, endocarditis
  • right ventricular outflow tract

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

High incidence of late infective endocarditis in bovine jugular vein valved conduits. / Beckerman, Ziv; De León, Luis E.; Zea-Vera, Rodrigo; Mery, Carlos; Fraser, Charles.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 156, No. 2, 01.08.2018, p. 728-734.e2.

Research output: Contribution to journalArticle

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title = "High incidence of late infective endocarditis in bovine jugular vein valved conduits",
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.",
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T1 - High incidence of late infective endocarditis in bovine jugular vein valved conduits

AU - Beckerman, Ziv

AU - De León, Luis E.

AU - Zea-Vera, Rodrigo

AU - Mery, Carlos

AU - Fraser, Charles

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N2 - 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.

AB - 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.

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KW - right ventricular outflow tract

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