Use of saphenous vein allografts for aortopulmonary artery anastomoses in neonates with complex cyanotic congenital heart disease
- 28 Downloads
A saphenous vein allograft was used to create an aortopulmonary communication in 16 infants with cyanotic congenital heart disease and ductus-dependent pulmonary blood flow. These grafts measured from 3 to 8 mm in diameter and were placed between the aorta and main pulmonary artery in eight patients, between aorta and right pulmonary artery in eight, and between aorta and left pulmonary artery in one (one child had two grafts). Before heparin was used, early in the series, four of these grafts occluded and three of the four infants died during attempted revision. Another infant died early from renal failure. Late mortality has claimed four: one from cerebral hemorrhage, two from hypoxia, and one at open-heart surgery for repair. There are eight late survivors (50%).
Most of the allografts were used before small diameter Gore-Tex was available; in more recent patients, 4- to 6-mm Gore-Tex grafts have been used. In our most recent patient, however, the attempt to place a Gore-Tex graft was unsuccessful, but the more pliable saphenous vein graft was readily placed and an adequate shunt obtained. Both the saphenous vein graft and the Gore-Tex have the advantage of providing pulmonary flow without the higher risk of congestive failure or pulmonary hypertension seen in patients with a Waterston or Potts anastomosis. They are easier to perform, require less anesthesia time than the Blalock-Taussig shunt, last as long as the Blalock-Taussig when done under similar conditions, and are easy to take down at the time of total repair.
Key wordsDuctus-dependent lesions Palliative cardiac surgery Saphenous vein allografts
Unable to display preview. Download preview PDF.
- 6.Hamaker WR, Doyle WF, O'Connell TJ, Gomez AC (1971) Subintimal obliterative proliferation in saphenous vein grafts.Ann Thorac Surg 13:488–493Google Scholar
- 11.Marbarger JP Jr, Sandza JG, Hartman AF Jr, Weldon CS (1978) Blalock-Taussig anastomosis: the preferred shunt in infants and newborns.Circulation (Suppl 1)58:73–77Google Scholar
- 12.Neches WH, Naifeh JG, Park SC, Lenox CC, Zuberbuhler JR, Siewers RD, Pontius RG, Bahnson HT (1975) Systemic-pulmonary artery anastomoses in infancy.J Thorac Cardiovasc Surg 76:921–927Google Scholar
- 18.Von Bernuth G, Ritter DG, Frye RL, Weidman WH, David GD, McGoon DC (1971) Evaluation of patients with tetralogy of Fallot and Potts anastomosis.Am J Cardiol 27:259–263A0946017 00004 CS-SPJRNPDF [HEADSUP]Google Scholar