32. SAPHENOUS VEIN HOMOGRAFT: A SUPERIOR CONDUIT FOR THE SYSTEMIC ARTERIAL SHUNT IN FIRST STAGE NORWOOD PALLIATION
Vincent K.H. Tam*, Kathy Murphy, James Parks, Anthony Raviele, Robert Vincent, Angel Cuadrado
Emory University School of Medicine and the Childrens Heart Center
Atlanta, Georgia, USA
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 3mm PTFE shunts have been successful, although catastrophic shunt thrombosis has occasionally been observed. To avoid thrombosis with a smaller conduit, saphenous vein homograft (SVG) was used to construct the modified BT shunts.
MATERIAL AND METHODS
From January 1998 to April 1999, 25 patients. weighing 3.1 kg (9 pts 3.0 kg or less), at age 8.9 days, underwent stage I Norwood using a SVG BT shunt. Common heart defects were: aortic atresia 8, mitral atresia and DORV 5, unbalanced AVC 5. Mean BT shunt size was 3.2mm, with 12 patients having 3mm or smaller shunts.
RESULTS
Thirty-day hospital mortality was 8% (2 of 25). No shunt thrombosis was seen despite banding the BT shunt in three patients. One patient had BT revision because of an anatomic issue not directly related to shunt material.
CONCLUSION
Excellent results may be achieved using SVG BT shunts in first stage of Norwood palliation. This conduit is less likely to thrombose, both acutely and chronically, allowing the use of appropriately smaller size shunts in small neonates.
