Systemic-pulmonary Artery Shunt Using PTFE Prosthesis (Gore-Tex). Early Results and Long-term Follow-up on 105 Consecutive Cases

Benedetto, Giuseppe Di; Tiraboschi, R; Vanini, Vittorio; Annecchino, P; Aiazzi, L; Caprioli, C.; Parenzan, L

doi:10.1055/s-2007-1023464

Cited by 17 publications

(6 citation statements)

References 4 publications

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“…Palliative shunts have become less common treatments for many cyanotic heart malformations since the advent of early corrective procedures.Nevertheless, certain subsets of patients require initial palliative surgery because their cardiac disorders are not generally amenable to initial corrective surgery, owing to either anatomic or physiologic causes.Moreover it may be an institutional practice in some centers to delay definitive corrective procedures until 12-18 months of age. In these patients a systemic to pulmonary artery shunt remains a necessity as a life-saving or temporizing form of palliation (1, 4, 5). The modified BT shunt involves interposing a Gore-Tex graft between the subclavian or innominate artery and the ipsilateral PA (3).…”

Section: Discussionmentioning

confidence: 99%

“…In these patients a systemic to pulmonary artery shunt remains a necessity as a life-saving or temporizing form of palliation (1, 4, 5). The modified BT shunt involves interposing a Gore-Tex graft between the subclavian or innominate artery and the ipsilateral PA (3). This shunt can be performed with or without CPB via a thoracotomy or median sternotomy.…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, positive pressure ventilation decreases pulmonary blood flow to the surgically created shunts, thereby compromising shunt function. Thus, the shortest possible duration of mechanical ventilation and ICU stay is desirable (1, 5). The use of inhalational anesthetic agents in lieu of narcotics may shorten the duration of mechanical ventilation and ICU stay, but may be associated with myocardial depression and dysarrythmias, especially seen with halothane.…”

Section: Introductionmentioning

confidence: 99%

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Desflurane Versus Opioid Anesthesia for Cardiac Shunt Procedures in Infants With Cyantoic Congential Heart Disease

2013

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BackgroundPlacement of a Blalock-Taussig (BT) shunt is frequently performed for palliation of cyanotic congenital heart disease (CCHD).ObjectivesInhalational anesthetics, when used in adult heart surgery, offer advantages of myocardial protection and decrease in use of inotropes, duration of ventilation, ICU and hospital length of stay (LOS).There is little literature, however, in the comparative use of inhalational and narcotic anesthesia in CCHD.Patients and MethodsFollowing Institutional Ethical Review Board approval and parental consent, 35 patients presenting for BT shunt were prospectively randomized to receive either a desflurane anesthetic or a narcotic anesthetic. Institutional practice for all patients undergoing BT shunt is to undergo cardiopulmonary bypass (CPB) following median sternotomy. Induction was accomplished with 5-7% sevoflurane in 100% oxygen, 2ug/kg fentanyl, 0.05mg/kg midazolam and 0.1mg/kg vecuronium. After intubation, patients in the narcotic group (n=16) received an additional 5-10ug/kg fentanyl, 0.1mg/kg midazolam, 100% oxygen and vecuronium. Patients in the inhalational group (n=19) received desflurane, 0.6-1 MAC, 100% oxygen, 0.05mg/kg midazolam, IV paracetamol 15mg/kg and vecuronium. At the end of surgery, patients were transferred to the ICU and received IV paracetamol and midazolam. Ventilation was weaned when the patient was hemodynamically stable. Demographics, baseline, intra and post-op heart rates, duration of inotrope use, ICU and hospital LOS, pre and post-op creatinine and serious adverse events (SAE) were recorded. Data were analyzed using Student, paired t, Mann-Whitney U and Chi square/Fisher exact tests, P < 0.05 significant.ResultsDemographic data were similar, except for a modestly higher pre-op heart rate in the group receiving opioid anesthesia. Patients receiving desflurane had a significantly shorter duration of mechanical ventilation and length of ICU and hospital stay. Inotrope use was similar in both groups. The group receiving opioid anesthesia had an increase in creatinine post operatively which was not observed in the desflurane group. There was no difference in incidence of significant adverse events in either group.ConclusionsUse of inhalational anesthesia has increased in adult cardiac surgery and has proved to reduce duration of elective ventilation, decrease ICU and hospital LOS, and mortality. Inhalational anesthetics are less well-studied in CCHD. In the current study, desflurane was chosen because of its low solubility, decreased recovery time and lack of metabolism or organ system toxicities. Although it is a popular belief that desflurane is associated with tachycardia and airway irritation, findings of the current study are consistent with those of the previous works demonstrating a lack of these side effects below 1 MAC3. No hemodynamic instability was encountered and there was no evidence that desflurane exerted a negative inotropic effect. Markers of cardio protection were not examined, although desflurane may have had a renal protective effe...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Desflurane Versus Opioid Anesthesia for Cardiac Shunt Procedures in Infants With Cyantoic Congential Heart Disease

2013

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“…O fechamento ou a estenose tardia do shunt varia de 3 a 20% em diversas séries relatadas e parece ser mais freqüente quando a operação é realizada em neonatos (4,6,(14)(15)(16) . Em nossa experiência, isso ocorreu em apenas uma criança (3,8%), submetido a um novo shunt seis meses depois da primeira operação.…”

Section: Comentáriosunclassified

Tratamento cirúrgico da tetralogia de Fallot no primeiro ano de vida

Neto¹,

Gomes²,

Lapa³

et al. 2000

Rev Bras Cir Cardiovasc

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“…Indications, effectiveness and long-term results of palliative treatment of congenital heart defects with a modified systemic-to-pulmonary artery shunt (Blalock-Taussig [BT] shunt) are well established [1]. When the total correction of a defect is made, a BT shunt is routinely closed during cardiac surgery or, less frequently, after cardiac surgery using interventional cardiology procedures.…”

Section: Introductionmentioning

confidence: 99%

Transcatheter closure of Blalock-Taussig anastomosis with brachial access in a child with obstruction of the left subclavian artery and secondary subclavian steal syndrome

Surmacz¹,

Moszura²,

Mroziński³

et al. 2012

pwki

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A b s t r a c tIn case of significant hypoxia in the course of congenital heart defect, when definite surgery is difficult, various palliative procedures are performed. One of the most frequently used is a modified Blalock-Taussig (BT) anastomosis. The BT anastomosis is closed during cardiac surgery. In some patients, BT anastomosis remains open after the surgery and requires closure by cardiac intervention using different types of closure devices. We describe a case of percutaneous closure of Blalock-Taussig anastomosis in a 4-yearold boy, with occluded left subclavian artery, presence of collateral circulation, and the subclavian artery steal syndrome to the left pulmonary artery through the patent BT anastomosis.Key words: Blalock-Taussig anastomosis, percutaneous closure S t r e s z c z e n i e W przypadku istotnego niedotlenienia w przebiegu wrodzonej sinicznej wady serca oraz niemożności przeprowadzenia operacji radykalnej u pacjentów wykonuje się różnego rodzaju zabiegi łagodzące. Jednym z częściej wykonywanych jest zmodyfikowane zespolenie Blalocka-Taussig (BT). Elementem końcowej korekcji wady jest zamknięcie zespolenia podczas operacji kardiochirurgicznej. U niektórych pacjentów, z różnych powodów, zespolenie BT pozostaje drożne po zabiegu i wymaga zamknięcia interwencyjnego z zastosowaniem różnego rodzaju implantów. Przedstawiono przypadek przezskórnego zamknięcia zespolenia BT u 4-letniego chłop-ca z niedrożnością lewej tętnicy podobojczykowej z obecnością krążenia obocznego przez tętnicę kręgową oraz zespołem podkradania do lewej tętnicy płucnej przez drożne zespolenie BT.Słowa kluczowe: zespolenie Blalocka-Taussig, zamknięcie przezskórne

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Systemic-pulmonary Artery Shunt Using PTFE Prosthesis (Gore-Tex). Early Results and Long-term Follow-up on 105 Consecutive Cases

Cited by 17 publications

References 4 publications

Desflurane Versus Opioid Anesthesia for Cardiac Shunt Procedures in Infants With Cyantoic Congential Heart Disease

Desflurane Versus Opioid Anesthesia for Cardiac Shunt Procedures in Infants With Cyantoic Congential Heart Disease

Tratamento cirúrgico da tetralogia de Fallot no primeiro ano de vida

Transcatheter closure of Blalock-Taussig anastomosis with brachial access in a child with obstruction of the left subclavian artery and secondary subclavian steal syndrome

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