Truncus Arteriosus Repair With Bovine Jugular Xenograft

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This video demonstrates the surgical repair of type I truncus arteriosus using a bovine internal jugular xenograft for right ventricular outflow tract (RVOT) reconstruction, highlighting key operative steps and surgical decision-making.  

The key steps demonstrated in the video are:

• Mobilization and looping of branch pulmonary arteries for antegrade cardioplegia delivery 
• Standard bicaval cannulation with antegrade root cardioplegia 
• Taking the pulmonary confluence off from the aorta 
• Pericardial patching of the aorta 
• Ventriculotomy and closure of sub-truncal ventricular septal defect (VSD) 
• Fashioning and anastomosis of the bovine jugular vein xenograft 

The reduced availability of homografts in many developing countries necessitates the use of alternative conduits for RVOT reconstruction during  the repair of truncus arteriosus. The bovine jugular venous valved conduit is a glutaraldehyde-preserved bovine jugular vein containing a native trileaflet venous valve. It has become a practical and widely used alternative in regions where homografts are scarce. Several studies have demonstrated its safety, efficacy, and durability in neonatal and infant truncus repair (1). 

In truncus physiology with preoperative pulmonary hypertension, maintaining a competent RVOT valve is particularly important, as the avoidance of pulmonary regurgitation contributes to a more stable and predictable postoperative course. The safety and long-term performance of the xenograft in other anatomic subsets beyond truncus arteriosus have also been reported (2). 

References

1. Hickey E, McCrindle BW, Blackstone EH, et al. Jugular venous valved conduit (Contegra) matches allograft performance in infant truncus arteriosus repair. Eur J Cardiothorac Surg. 2008;33:890–898.
2. Dave H, Mueggler E, Comber M. Risk factor analysis of 170 single-institutional Contegra implantations in the pulmonary position. Ann Thorac Surg. 2011;91:195–203.

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