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Femoral vein homograft as Sano shunt results in improved pulmonary artery growth after Norwood operation

Published online by Cambridge University Press:  29 August 2017

Mario Briceno-Medina ,
T. K. Susheel Kumar ,
Shyam Sathanandam ,
Umar Boston ,
Michael Perez ,
Jerry Allen ,
David Zurakowski ,
Michel Ilbawi  and
Christopher J. Knott-Craig
Mario Briceno-Medina*
Affiliation:
Department of Pediatric Cardiology, Le Bonheur Children’s Hospital and University of Tennessee Health Science Center, Memphis, Tennessee, United States of America
T. K. Susheel Kumar
Affiliation:
Department of Cardiothoracic Surgery, Le Bonheur Children’s Hospital and University of Tennessee Health Science Center, Memphis, Tennessee, United States of America
Shyam Sathanandam
Affiliation:
Department of Pediatric Cardiology, Le Bonheur Children’s Hospital and University of Tennessee Health Science Center, Memphis, Tennessee, United States of America
Umar Boston
Affiliation:
Department of Cardiothoracic Surgery, Le Bonheur Children’s Hospital and University of Tennessee Health Science Center, Memphis, Tennessee, United States of America
Michael Perez
Affiliation:
Department of Pediatric Cardiology, Le Bonheur Children’s Hospital and University of Tennessee Health Science Center, Memphis, Tennessee, United States of America
Jerry Allen
Affiliation:
Department of Cardiothoracic Surgery, Le Bonheur Children’s Hospital and University of Tennessee Health Science Center, Memphis, Tennessee, United States of America
David Zurakowski
Affiliation:
Departments of Anesthesia and Surgery, Harvard Medical School, Boston, Massachusetts, United States of America
Michel Ilbawi
Affiliation:
Department of Cardiothoracic Surgery, Advocate Christ Medical Center, Chicago, Illinois, United States of America
Christopher J. Knott-Craig
Affiliation:
Department of Cardiothoracic Surgery, Le Bonheur Children’s Hospital and University of Tennessee Health Science Center, Memphis, Tennessee, United States of America
*
Correspondence to: Mario Briceno-Medina, MD, Pediatric Cardiologist, Department of Pediatric Cardiology, Le Bonheur Children’s Hospital, University of Tennessee Health Science Center, The Heart Institute, 3rd floor, 49 North Dunlap, Memphis, TN 38103, United States of America. Tel: 901 287 5995; Fax: 901 287 7222; E-mail: mbriceno@uthsc.edu
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Abstract

Objective

To evaluate differences in interstage growth of pulmonary arteries between use of polytetrafluoroethylene and femoral vein homograft as Sano shunt during stage-I Norwood palliation.

Methods

A retrospective review of all patients who survived to the second stage following Norwood–Sano operation at two institutions was performed. Either polytetrafluoroethylene or the valved segment of femoral vein homograft was used for construction of the Sano shunt. The size of pulmonary arteries was compared at pre-Glenn catheterisation.

Results

A total of 48 neonates with the diagnosis of hypoplastic left heart syndrome or its variants comprised the study population. Femoral vein homograft of 5–6 mm diameter was used in 14 and polytetrafluoroethylene graft of 5 mm was used in 34 patients. The two groups were comparable in terms of preoperative demographics and age at time of pre-Glenn catheterisation (3.9±0.7 versus 3.4±0.8 months, p=0.06). Patients who received femoral vein homograft demonstrated a significantly higher pre-Glenn Nakata index [264 (130–460) versus 165 (108–234) mm2/m2, p=0.004]. The individual branch pulmonary arteries were significantly larger in the femoral vein group (right, 7.8±3.6 versus 5.0±1.2, p=0.014; left, 7.2±2.1 versus 5.6±1.9, p=0.02). There were no differences in cardiac index, Qp:Qs, ventricular end-diastolic pressure or systemic oxygen saturations.

Conclusions

Utilisation of a valved segment of femoral vein homograft as right ventricle to pulmonary artery conduit during Norwood–Sano operation confers better interstage growth of the pulmonary arteries. Further studies are needed to evaluate the impact of femoral vein homograft on single ventricle function.

Keywords

Pulmonary artery growthfemoral vein homograftSano shuntNorwood operation
Type
Original Articles
Information
Cardiology in the Young , Volume 28 , Issue 1 , January 2018 , pp. 118 - 125
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Copyright
© Cambridge University Press 2017 

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