Meta-analysis of valved conduits in right ventricular outflow tract reconstruction: comparison of homograft, bovine jugular vein, and EPTFE valved conduits

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.