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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: eerez@cookchildrens.org
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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

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