Saphenous vein homograft: a superior conduit for the systemic arterial shunt in the Norwood operation.
BACKGROUND
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.
Tam
V K
VK
Section of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia 30322, USA. vtam01@emory.edu
Murphy
K
K
Parks
W J
WJ
Raviele
A A
AA
Vincent
R N
RN
Strieper
M
M
Cuadrado
A R
AR
D000792:Angiography; D005260:Female; D006330:Heart Defects, Congenital / Q000401:mortality / Q000601:surgery; D017052:Hospital Mortality; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000401:mortality / Q000601:surgery*; D007231:Infant, Newborn; D008297:Male; D010166:Palliative Care; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery; D012086:Reoperation; D015996:Survival Rate; D014184:Transplantation, Homologous; D014680:Veins / Q000473:pathology / Q000637:transplantation*