Saphenous vein homograft: a superior conduit for the systemic arterial shunt in the Norwood operation

Tam, Vincent K.H; Murphy, K.; Parks, W. James; Raviele, A; Vincent, Robert; Strieper, Margaret J.; Cuadrado, Angel R.

doi:10.1016/s0003-4975(01)02467-5

Cited by 32 publications

(26 citation statements)

References 5 publications

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“…A fresh frozen vein homograft 12 and Hank's solution‐stored or cryopreserved saphenous vein grafts 13 were attempted in the modified B‐T shunts, and functioned well up to six years after the procedure. A saphenous vein graft was also used in the B‐T shunt as a part of stage I Norwood procedure aiming at preventing thrombosis with a smaller conduit in infants 14 . Danilowicz et al 12 and Wojtalik et al 15 explained the phenomenon of minimal immunological reaction between the vein homograft donor and recipient with the “window of opportunity” theory, in that organ transplantation shortly after birth would have an excellent result even with poor matches of major histocompatibility.…”

Section: Conduit Choicesmentioning

confidence: 99%

The Blalock-Taussig Shunt

Yuan

Shinfeld

Raanani

2009

Journal of Cardiac Surgery

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Background and aim of the study: Even though the Blalock-Taussig (B-T) shunt, either classic or modified, has been advocated and successfully employed in clinical practice for more than half a century, a systemic review on this procedure is still scanty. This warrants us a zest in making a comprehensive survey on this subject. Methods: Articles were extensively retrieved from the MEDLINE database of National Library of Medicine USA if the abstract contained information relevant to the B-T shunt in terms of the conduit options, modified surgical techniques, surgical indications, short-and long-term results, complications, and prognosis. Further retrieval was undertaken by manually searching the reference list of relevant papers. Results: Classical or modified B-T shunts, either on ipsilateral or contralateral side to the aortic arch, can be performed on patients of any age with minimum postoperative complications and low operative mortality. Expended polytetrafluoroethylene has gained satisfactory long-term patency rate in the construction of the modified B-T shunt. Excellent pulmonary artery growth was observed in the patients with a modified B-T shunt, and it has shown superb prognosis over the classic with regard to hemodynamics, patency rate, and survival. Conclusions: The modified B-T shunt that was developed on basis of the classic fashion remains the preferable palliative procedure aiming at enhancing pulmonary blood flow for neonates and infants with complicated cyanotic congenital heart defects. The modified B-T shunt is technically simpler with less dissection, and blood flow to the respective arm is not jeopardized. It has been proved to be of low risk, excellent palliation, and is associated with excellent pulmonary artery growth, has become the most effective palliative shunt procedure of today. doi: 10.1111/j.1540-8191.2008.00758.x (J Card Surg 2009;24:101-108) Complex cyanotic congenital heart disease may occasionally be unsuitable for surgical correction, but for palliative procedure only. 1 In 1945, prior

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Section: Conduit Choicesmentioning

confidence: 99%

The Blalock-Taussig Shunt

Yuan

Shinfeld

Raanani

2009

Journal of Cardiac Surgery

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“…Preserved vein homografts tolerate repeated puncture by large dialysis needles. Similarly, when satisfactory autologous SVGs are not available, cryopreserved homologous SVGs, either cryopreserved or denatured, can be an alternative conduit to the autologous ones in coronary artery bypass,127 construction of aortopulmonary communication,77 a modified Blalock-Taussig shunt,7879 and complex limb-salvage procedures 128129. Some authors127130131 have suggested that use of such conduits should be limited due to poor patency.…”

Section: Discussionmentioning

confidence: 99%

“…This provides a natural, inexpensive, and more hemostatic alternative to the use of prosthetic grafts 75. A homologeous SVG can be used as a conduit to replace the malignancy-invaded inferior vena cava,76 to create an aortopulmonary communications,77 or to construct modified Blalock-Taussig shunts7879 in patients with cyanotic congenital heart disease who have satisfactory patency.…”

Section: Cardiac Surgerymentioning

confidence: 99%

A Reappraisal of Saphenous Vein Grafting

Yuan

Hua

2011

Annals of Saudi Medicine

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Autologous saphenous vein grafting has been broadly used as a bypass conduit, interposition graft, and patch graft in a variety of operations in cardiac, thoracic, neurovascular, general vascular, vascular access, and urology surgeries, since they are superior to prosthetic veins. Modified saphenous vein grafts (SVG), including spiral and cylindrical grafts, and vein cuffs or patches, are employed in vascular revascularization to satisfy the large size of the receipt vessels or to obtain a better patency. A loop SVG helps flap survival in a muscle flap transfer in plastic and reconstructive surgery. For dialysis or transfusion purposes, a straight or loop arteriovenous fistula created in the forearm or the thigh with an SVG has acceptable patency. The saphenous vein has even been used as a stent cover to minimize the potential complications of standard angioplasty technique. However, the use of saphenous vein grafting is now largely diminished in treating cerebrovascular disorders, superior vena cava syndrome, and visceral revascularization due to the introduction of angioplasty and stenting techniques. The SVG remains the preferable biomaterial in coronary artery bypass, coronary ostioplasty, free flap transfer, and surgical treatment of Peyronie disease. Implications associated with saphenous vein grafting in vascular access surgery for the purpose of dialysis and chemotherapy are considerable. Vascular cuffs and patches have been developed as an important and effective means of enhancing the patency rates of the grafts by linking the synthetic material to the receipt vessel. In addition, saphenous veins can be a cell source for tissue engineering. We review the versatile roles that saphenous vein grafting has played as well as its current status in therapy.

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“…3 mm) can certainly increase the risk for shunt thrombosis [23]. In an effort to avoid shunt thrombosis and early intervention, some centers have attempted to use alternative conduit material such as saphenous vein homografts [34,35], xenopericardial valved conduits [32], and homograft valved conduits [36 ]. Some centers prefer the use of valved conduits to eliminate diastolic regurgitation and right ventricle volume load [32,35,37].…”

Section: Shunt Selectionmentioning

confidence: 99%

Stage I palliation for hypoplastic left heart syndrome: Norwood versus Sano modification

Reemtsen

Pike²,

Starnes³

2007

Current Opinion in Cardiology

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The classic Norwood procedure and Sano modification each have specific advantages and disadvantages in both the short and long term. Data comparing the two techniques are nonrandomized, contradictory, and utilize historical controls. The optimal shunt to improve survival to the second-stage palliation is unknown. A multicenter randomized clinical trial comparing the Sano with the modified Blalock-Taussig shunt in hypoplastic left heart syndrome or variants is currently in progress and should hopefully provide future guidelines for shunt selection based on clinical presentation.

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Saphenous vein homograft: a superior conduit for the systemic arterial shunt in the Norwood operation

Cited by 32 publications

References 5 publications

The Blalock-Taussig Shunt

The Blalock-Taussig Shunt

A Reappraisal of Saphenous Vein Grafting

Stage I palliation for hypoplastic left heart syndrome: Norwood versus Sano modification

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