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Saphenous vein homograft: a superior conduit for the systemic arterial shunt in the Norwood operation.

AbstractBACKGROUND:
Excessive pulmonary blood flow increases ventricular volume work in the face of inadequate systemic cardiac output, low diastolic blood pressure, and inadequate coronary perfusion. Using the smallest available 3-mm polytetrafluoroethylene shunts have been successful, although catastrophic shunt thrombosis has occasionally been observed. To avoid thrombosis with a smaller conduit, saphenous vein homografts (SVG) were used to construct the modified Blalock-Taussig (BT) shunts.
METHODS:
From January 1998 to April 1999, 25 patients weighing 3.1 kg (3.0 kg or less, n = 9), at a mean age of 8.9 days, underwent stage I Norwood using an SVG BT shunt. Common heart defects were aortic atresia (n = 8), mitral atresia and double-outlet right ventricle (n = 5), and unbalanced AVC (n = 5). Mean BT shunt size was 3.2 mm, with 12 patients having shunts that were 3 mm or smaller.
RESULTS:
Thirty-day hospital mortality was 8% (2 of 25). No shunt thrombosis was seen, despite banding the BT shunt in 3 patients. One patient had BT revision because of an anatomic issue not directly related to the shunt material.
CONCLUSIONS:
Excellent results may be achieved using SVG BT shunts in the Norwood operation. This conduit seems less likely to thrombose, both acutely and chronically, allowing the use of appropriately smaller-sized shunts in small neonates.
AuthorsV K Tam, K Murphy, W J Parks, A A Raviele, R N Vincent, M Strieper, A R Cuadrado
JournalThe Annals of thoracic surgery (Ann Thorac Surg) Vol. 71 Issue 5 Pg. 1537-40 (May 2001) ISSN: 0003-4975 [Print] Netherlands
PMID11383796 (Publication Type: Journal Article)
Topics
  • Angiography
  • Female
  • Heart Defects, Congenital (mortality, surgery)
  • Hospital Mortality
  • Humans
  • Hypoplastic Left Heart Syndrome (mortality, surgery)
  • Infant, Newborn
  • Male
  • Palliative Care
  • Postoperative Complications (diagnostic imaging, mortality, surgery)
  • Reoperation
  • Survival Rate
  • Transplantation, Homologous
  • Veins (pathology, transplantation)

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