Prosthesis selection for reconstruction of superior vena cava: comparison of midterm patency rates

Objectives: This study compared the mid-term patency of expanded polytetrafluoroethylene grafts without rings versus that of bovine pericardial conduits used for superior vena cava reconstruction for various thoracic diseases.

Methods: Among 80 patients who underwent superior vena cava resection and reconstruction between 2009 and 2023 at our institution, 31 patients who received polytetrafluoroethylene grafts without rings (Polytetrafluoroethylene group) and 28 patients who received bovine pericardial conduits (Bovine group) were enrolled. Median follow-up durations were 19.5 and 64.6 months in the Polytetrafluoroethylene and Bovine groups, respectively. Primary outcome was midterm graft patency rate, and secondary outcomes were early and midterm clinical outcomes, including all-cause mortality and superior vena cava reintervention.

Results: Operative mortality was 1.7%. Cumulative incidence of all-cause mortality was not significantly different between the groups. Graft occlusion was detected in 22 patients. Cumulative incidence of graft occlusion was 24.2%, 36.4%, 42.4%, 48.5% and 60.6% at 1 month, 3 months, 6 months, 1 year and 2 years, respectively, in the Bovine group, whereas no graft occlusion was observed in the Polytetrafluoroethylene group (P = 0.007). Although the incidence of graft occlusion was higher in the Bovine group, cumulative incidence of reintervention was not significantly different between the groups (0.0% vs 3.0% in Polytetrafluoroethylene vs Bovine groups at 1 year, P = 0.406). Multivariate analysis demonstrated that bovine pericardial conduit (polytetrafluoroethylene graft as reference) and left brachiocephalic vein reconstruction (right brachiocephalic vein reconstruction as reference) were significant risk factors for graft occlusion.

Conclusions: In superior vena cava reconstruction, polytetrafluoroethylene grafts without rings were superior to bovine pericardial conduits in terms of midterm graft patency.