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This meta-analysis of 28 retrospective cohort studies (n=3966) and 113 case series (n=16367) compared homograft, bovine jugular vein (BJV), and ePTFE valved conduits for RVOT reconstruction, finding no significant difference in mortality or replacement rate between the three conduit types, but a significantly higher incidence of infective endocarditis (IE) with BJV conduits compared to homografts. Pooled case series data showed numerically higher mortality and replacement rates for homografts and BJV compared to ePTFE, with BJV also exhibiting a higher IE incidence.
Bovine jugular vein valved conduits for RVOT reconstruction are associated with a significantly higher risk of infective endocarditis compared to homografts, despite comparable mortality and replacement rates.
BACKGROUND Homograft, bovine jugular vein (BJV) and expanded polytetrafluoroethylene (ePTFE) valved conduits are most common valved conduits for reconstructing right ventricular outflow tracts (RVOT), while the performance of those three valved conduits was still unclear. MATERIALS AND METHODS We searched Ovid MEDLINE, Ovid Embase, as well as Chinese databases of SinoMed, CNKI, and Wanfang from 1 January 2000 to 26 August 2024 to identify studies on RVOT reconstruction with homograft, BJV, and ePTFE valved conduits. We included studies reporting the outcomes of mortality, replacement rate, and the incidence of infective endocarditis. The "meta" and "metafor" packages in R version 4.2.1 were used for evidence synthesis. ROBINS-I tool was used for assessing the risk of bias. This study is registered on PROSPERO (CRD42024582184). RESULTS According to 28 retrospective cohort studies (n = 3966), there was no significant difference in mortality and replacement rate between homograft, BJV, and ePTFE. However, the IE incidence in BJV was significantly higher than that in homograft (RR = 3.63, 95% CI: 1.69-7.83, P < 0.01). Based on the pooled results of 113 case-series reports (n = 16 367), the total mortality of homograft, BJV, and ePTFE was 8% (95% CI: 6%-9%), 5% (95% CI: 4%-7%), and 3% (95% CI: 3%-4%), respectively. The replacement rate of homograft, BJV, and ePTFE was 9% (95% CI: 6%-13%), 9% (95% CI:6%-12%), and 4% (95% CI: 2%-9%), respectively. The incidence of IE for BJV was 6% (95% CI: 3%-10%), which was higher than 2% for homograft (95% CI: 1%-4%) and 1% for ePTFE (95% CI: 1%-2%). CONCLUSIONS While BJV and ePTFE are viable alternatives with comparable mortality and replacement rate to homograft, the elevated IE risk in BJV necessitates cautious patient selection and monitoring.
