Hostname: page-component-586b7cd67f-t7fkt Total loading time: 0 Render date: 2024-11-23T06:30:58.849Z Has data issue: false hasContentIssue false
  • English
  • Français

Outcome in infants less than 3 kilograms for placement of saphenous venous homografts as systemic-to-pulmonary arterial shunts

Published online by Cambridge University Press:  01 August 2008

Eldad Erez ,
David Bush ,
Vincent K.H. Tam ,
Nancy A. Doublin  and
Jeanie Stakes
Eldad Erez*
Affiliation:
Cook Children’s Medical Center, University of North Texas Health Science Center, Fort Worth, Texas, United States of America
David Bush
Affiliation:
Cook Children’s Medical Center, University of North Texas Health Science Center, Fort Worth, Texas, United States of America
Vincent K.H. Tam
Affiliation:
Cook Children’s Medical Center, University of North Texas Health Science Center, Fort Worth, Texas, United States of America
Nancy A. Doublin
Affiliation:
Cook Children’s Medical Center, University of North Texas Health Science Center, Fort Worth, Texas, United States of America
Jeanie Stakes
Affiliation:
Cook Children’s Medical Center, University of North Texas Health Science Center, Fort Worth, Texas, United States of America
*
Correspondence to: Eldad Erez, MD, Cook Children’s Medical Center, 901 Seventh Avenue, Suite 330, Fort Worth, Texas 76104, USA. Tel: (1) 682 885 6400; Fax: (1) 682 885 6101; E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Establishing stable and adequate flow of blood to the lungs using a systemic-to-pulmonary arterial shunt in infants with low birth weight may involve significant morbidity and mortality. We reviewed our experience with this procedure in patients weighing less than 3 kilograms.

Methods

Between June, 2002, and June, 2007, we placed systemic-to-pulmonary arterial shunts in 32 infants weighing less than 3 kilograms, the range being 1.8 to 2.86 kg, with a median of 2.5 kg. The median age at placement of the shunt was 8 days, with a range from 2 to 70 days. In 17 patients (53%), the anatomic defects had produced a functionally univentricular heart, while 15 (47%) had defects which permitted staging to biventricular repair. Patients staged to univentricular palliation were much more likely to have a circulation dependent on the arterial duct as compared with those staged to biventricular palliation (p < 0.001). The latter patients tended to have smaller pulmonary arteries, significantly the left pulmonary artery, which has a median diameter of 3.6 versus 2.0 mm, p = 0.01. In all patients a saphenous venous homograft was used as the conduit, its size ranging in diameter from 2.5 to 4 mm, with a median of 3.0 mm.

Results

The overall hospital mortality rate for the entire cohort was 6.25%, with 2 patients dying. There was no significant difference between the two groups with regard to length of stay in intensive care or hospital. Follow-up has ranged from 3 months to 4.7 years, with a mean of 2.1 years). Of those with functionally univentricular hearts, 3 have subsequently died, along with 1 patient having a biventricular circulation (p = 0.3). All deaths occurred before takedown of the shunt. A trend toward longer survival was noted in those with biventricular as compared to functionally univentricular circulations (p = 0.06).

Conclusion

Systemic-to-pulmonary arterial shunts can be constructed safely in infants with biventricular physiology born with low weight. Those having functionally univentricular circulations carry an increased rate of mortality for the period of shunting. Using the saphenous venous homograft permits use of smaller grafts, which does not significantly increase the risk for thrombosis or survival when compared to previous studies using polytetrafluoroethylene grafts.

Keywords

Congenital heart defectspalliative surgeryneonateslow birth weight
Type
Original Article
Information
Cardiology in the Young , Volume 18 , Issue 4 , August 2008 , pp. 386 - 391
Copyright
Copyright © Cambridge University Press 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Reddy, VM, Hanley, FL. Cardiac surgery in infants with very low birth weight. Semin Pediatr Surg 2000; 9: 91–95.CrossRefGoogle ScholarPubMed
2.Kopf, GS, Mello, DM. Surgery for congenital heart disease in low-birth weight neonates: a comprehensive statewide Connecticut program to improve outcomes. Conn Med 2003; 67: 327–332.Google ScholarPubMed
3.Tamisier, D, Vouhe, PR, Vernant, F, Leca, F, Massot, C, Neveux, JY. Modified Blalock-Taussig shunts: results in infants less than 3 months of age. Ann Thorac Surg 1990; 49: 797–801.CrossRefGoogle ScholarPubMed
4.Duncan, BW, Mee, RB, Prieto, LR, et al. Staged repair of tetralogy of Fallot with pulmonary atresia and major aortopulmonary collateral arteries. J Thorac Cardiovasc Surg 2003; 126: 694–702.CrossRefGoogle ScholarPubMed
5.Ishikawa, S, Takahashi, T, Sato, Y, et al. Growth of the pulmonary arteries after systemic-pulmonary shunt. Ann Thorac Cardiovasc Surg 2001; 7: 337–340.Google ScholarPubMed
6.de Leval, MR, McKay, R, Jones, M, Stark, J, Macartney, FJ. Modified Blalock-Taussig shunt. Use of subclavian artery orifice as flow regulator in prosthetic systemic-pulmonary artery shunts. J Thorac Cardiovasc Surg 1981; 81: 112–119.CrossRefGoogle ScholarPubMed
7.Al Jubair, KA, Al Fagih, MR, Al Jarallah, AS, et al. Results of 546 Blalock-Taussig shunts performed in 478 patients. Cardiol Young 1998; 8: 486–490.CrossRefGoogle ScholarPubMed
8.Gold, JP, Violaris, K, Engle, MA, et al. A five-year clinical experience with 112 Blalock-Taussig shunts. J Card Surg 1993; 8: 9–17.CrossRefGoogle ScholarPubMed
9.Sivakumar, K, Shivaprakasha, K, Rao, SG, Kumar, RK. Operative outcome and intermediate term follow-up of neonatal Blalock-Taussig shunts. Indian Heart J 2001; 53: 66–70.Google ScholarPubMed
10.Bove, T, Francois, K, De Groote, K, et al. Outcome analysis of major cardiac operations in low weight neonates. Ann Thorac Surg 2004; 78: 181–187.CrossRefGoogle ScholarPubMed
11.Fermanis, GG, Ekangaki, AK, Salmon, AP, et al. Twelve year experience with the modified Blalock-Taussig shunt in neonates. Eur J Cardiothorac Surg 1992; 6: 586–589.CrossRefGoogle ScholarPubMed
12.Danilowicz, D, Ishmael, RG, Doyle, EF, Isom, OW, Colvin, SB, Greco, MA. Use of saphenous vein allografts for aortopulmonary artery anastomoses in neonates with complex cyanotic congenital heart disease. Pediatr Cardiol 1984; 5: 13–17.CrossRefGoogle ScholarPubMed
13.Bogats, G, Kertesz, E, Katona, M, Toszegi, A, Kovacs, GS. Modified Blalock-Taussig shunt using allograft saphenous vein: six years’ experience. Ann Thorac Surg 1996; 61: 58–62.CrossRefGoogle ScholarPubMed
14.Jacobs, JP, Quintessenza, JA, Boucek, RJ, et al. Pediatric cardiac transplantation in children with high panel reactive antibody. Ann Thorac Surg 2004; 78: 1703–1709.CrossRefGoogle ScholarPubMed
15.Jacobs, JP, Quintessenza, JA, Chai, PJ, et al. Rescue cardiac transplantation for failing staged palliation in patients with hypoplastic left heart syndrome. Cardiol Young 2006; 16: 556–562.CrossRefGoogle ScholarPubMed
16.Odim, J, Portzky, M, Zurakowski, D, et al. Sternotomy approach for the modified Blalock-Taussig shunt. Circulation 1995; 92: 256–261.CrossRefGoogle ScholarPubMed
17.Ilbawi, MN, Grieco, J, DeLeon, SY, et al. Modified Blalock-Taussig shunt in newborn infants. J Thorac Cardiovasc Surg 1984; 88: 770–775.CrossRefGoogle ScholarPubMed