Risk factor analysis of 170 single-institutional contegra implantations in pulmonary position

Background: The aim of this study is to evaluate risk factors affecting survival of Contegra grafts used in the pulmonary position.

Methods: One hundred seventy Contegra implanted (2001 to 2007) in the pulmonary position for replacement after a prior repair (90), Ross procedure (29), tetralogy of Fallot and variants (22), truncus arteriosus (13), Rastelli procedure (8), and miscellaneous (8) were reviewed. Median age was 107 (0.1 to 894) months. Follow-up was 96% complete with a median duration of 65 (7 to 98) months.

Results: There were 7 early and 6 late deaths (none Contegra related) with a survival of 92%±2% at 98 months. Thirty-four Contegra were replaced at a median duration of 43 (7 to 82) months. Eight of 28 balloon-dilated Contegra remain palliated at 49 (23 to 73) months. Multivariate analysis showed Contegra less than 16 mm (p<0.001; HR [hazard ratio] 0.07), high pulmonary pressure (p<0.001; HR 4), and prior operation era (p=0.006; HR 0.3) as independent risk factors for Contegra replacement. The freedom from replacement for Contegra less than 16 mm and 16 mm or greater were 48%±8% and 98%±2%; for presence and absence of high pulmonary pressure were 52%±11% and 88%±3% and for era 1 and 2 were 77%±5% and 88%±4% at 60 months, respectively. Twenty-three of 123 surviving Contegra have a mean Doppler gradient greater than 20 mm Hg. Contegra less than 16 mm, smaller age group, obstructive arborization, and era 1 were significantly associated with higher gradients. While 18 (15%) surviving Contegra have moderate or more regurgitation, 88 (72%) have no significant gradient or regurgitation.

Conclusions: Contegra grafts integrate well into the body. Larger Contegra show predictable function with a survival approaching homografts over medium term. Better case selection as one ascends the learning curve tends to improve survival. With easy availability and predictable quality, Contegra grafts continue to be a promising complement to homografts.