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Beqaj H, Goldshtrom N, Linder A, Buratto E, Setton M, DiLorenzo M, Goldstone A, Barry O, Shah A, Krishnamurthy G, Bacha E, Kalfa D. Valved Sano conduit improves immediate outcomes following Norwood operation compared with nonvalved Sano conduit. J Thorac Cardiovasc Surg 2024; 167:1404-1413. [PMID: 37666412 DOI: 10.1016/j.jtcvs.2023.08.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 07/27/2023] [Accepted: 08/12/2023] [Indexed: 09/06/2023]
Abstract
OBJECTIVE Use of a valved Sano during the Norwood procedure has been reported previously, but its impact on clinical outcomes needs to be further elucidated. We assessed the impact of the valved Sano compared with the nonvalved Sano after the Norwood procedure in patients with hypoplastic left heart syndrome. METHODS We retrospectively reviewed 25 consecutive neonates with hypoplastic left heart syndrome who underwent a Norwood procedure with a valved Sano conduit using a femoral venous homograft and 25 consecutive neonates with hypoplastic left heart syndrome who underwent a Norwood procedure with a nonvalved Sano conduit between 2013 and 2022. Primary outcomes were end-organ function postoperatively and ventricular function over time. Secondary outcomes were cardiac events, all-cause mortality, and Sano and pulmonary artery reinterventions at discharge, interstage, and pre-Glenn time points. RESULTS Postoperatively, the valved Sano group had significantly lower peak and postoperative day 1 lactate levels (P = .033 and P = .025, respectively), shorter time to diuresis (P = .043), and shorter time to enteral feeds (P = .038). The valved Sano group had significantly fewer pulmonary artery reinterventions until the Glenn operation (n = 1 vs 8; P = .044). The valved Sano group showed significant improvement in ventricular function from the immediate postoperative period to discharge (P < .001). From preoperative to pre-Glenn time points, analysis of ventricular function showed sustained ventricular function within the valved Sano group, but a significant reduction of ventricular function in the nonvalved Sano group (P = .003). Pre-Glenn echocardiograms showed competent conduit valves in two-thirds of the valved Sano group (n = 16; 67%). CONCLUSIONS The valved Sano is associated with improved multi-organ recovery postoperatively, better ventricular function recovery, and fewer pulmonary artery reinterventions until the Glenn procedure.
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Affiliation(s)
- Halil Beqaj
- Section of Pediatric and Congenital Cardiac Surgery, Division of Cardiac, Thoracic, and Vascular Surgery, Department of Surgery, Columbia University Medical Center, New York-Presbyterian Morgan Stanley Children's Hospital, New York, NY
| | - Nimrod Goldshtrom
- Division of Neonatalogy, Department of Pediatrics, Columbia University Medical Center, New York-Presbyterian Morgan Stanley Children's Hospital, New York, NY
| | - Alexandra Linder
- Division of Pediatric Cardiology, Department of Pediatrics, Columbia University Medical Center, New York-Presbyterian Morgan Stanley Children's Hospital, New York, NY
| | - Edward Buratto
- Section of Pediatric and Congenital Cardiac Surgery, Division of Cardiac, Thoracic, and Vascular Surgery, Department of Surgery, Columbia University Medical Center, New York-Presbyterian Morgan Stanley Children's Hospital, New York, NY
| | - Matan Setton
- Division of Pediatric Cardiology, Department of Pediatrics, Columbia University Medical Center, New York-Presbyterian Morgan Stanley Children's Hospital, New York, NY
| | - Michael DiLorenzo
- Division of Pediatric Cardiology, Department of Pediatrics, Columbia University Medical Center, New York-Presbyterian Morgan Stanley Children's Hospital, New York, NY
| | - Andrew Goldstone
- Section of Pediatric and Congenital Cardiac Surgery, Division of Cardiac, Thoracic, and Vascular Surgery, Department of Surgery, Columbia University Medical Center, New York-Presbyterian Morgan Stanley Children's Hospital, New York, NY
| | - Oliver Barry
- Division of Pediatric Cardiology, Department of Pediatrics, Columbia University Medical Center, New York-Presbyterian Morgan Stanley Children's Hospital, New York, NY
| | - Amee Shah
- Division of Pediatric Cardiology, Department of Pediatrics, Columbia University Medical Center, New York-Presbyterian Morgan Stanley Children's Hospital, New York, NY
| | - Ganga Krishnamurthy
- Division of Neonatalogy, Department of Pediatrics, Columbia University Medical Center, New York-Presbyterian Morgan Stanley Children's Hospital, New York, NY
| | - Emile Bacha
- Section of Pediatric and Congenital Cardiac Surgery, Division of Cardiac, Thoracic, and Vascular Surgery, Department of Surgery, Columbia University Medical Center, New York-Presbyterian Morgan Stanley Children's Hospital, New York, NY
| | - David Kalfa
- Section of Pediatric and Congenital Cardiac Surgery, Division of Cardiac, Thoracic, and Vascular Surgery, Department of Surgery, Columbia University Medical Center, New York-Presbyterian Morgan Stanley Children's Hospital, New York, NY.
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Quintao R, Kwon JH, Bishara K, Rajab TK. Donor supply for partial heart transplantation in the United States. Clin Transplant 2023; 37:e15060. [PMID: 37354124 DOI: 10.1111/ctr.15060] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 05/24/2023] [Accepted: 06/13/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND Congenital heart disease (CHD) is the most common cause of birth defects worldwide. Valvular defects are a common form of CHDs, and, at this time, treatment options for children with unrepairable valve disease are limited. Issues with anticoagulation, sizing, and lack of growth in valve replacement options can lead to high mortality rates and incidence of reoperations. Partial heart transplantation, or transplantation of fresh valve allografts, has recently been described as a strategy to provide a durable and non-thrombogenic alternative to conventional prostheses and provide growth potential in pediatric patients. METHODS The United Network for Organ Sharing (UNOS) database was queried to analyze the number of pediatric donor hearts that were not recovered but had viable valves (n = 3565) between January 2010 and September 2021. Recoverable valves were grouped by donor age: infants (age < 1 year), toddlers (age ≥1 and <3 years), and children (age ≥3 and <18 years). Demographic characteristics of donors were analyzed between age groups. RESULTS Infants, toddlers, and children had a total of 344, 465, and 2756 hearts with recoverable valves, respectively, over the study period, representing an average of 29, 39, and 230 hearts with recoverable valves per year. CONCLUSION The results of our study identify the minimum donor supply for partial heart transplantation. The actual number is likely higher because it includes hearts not entered in the UNOS database and domino transplants from orthotopic heart transplant recipients. Partial heart transplantation is logistically feasible as there are recoverable valves available for all age groups, fulfilling a clinical need in pediatric patients with unrepairable valve disease.
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Affiliation(s)
- Ritchelli Quintao
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jennie H Kwon
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Katherine Bishara
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Taufiek Konrad Rajab
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
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Fujita S, Yamagishi M, Maeda Y, Itatani K, Asada S, Hongu H, Yamashita E, Takayanagi Y, Nakatsuji H, Yaku H. The effect of a valved small conduit on systemic ventricle–pulmonary artery shunt in the Norwood-type palliation. Eur J Cardiothorac Surg 2020; 57:1105-1112. [DOI: 10.1093/ejcts/ezz377] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 12/17/2019] [Accepted: 12/22/2019] [Indexed: 11/14/2022] Open
Abstract
Abstract
OBJECTIVES
The aim of this study was to clarify the impact of valved systemic ventricle–pulmonary artery (SV–PA) shunt on outcomes after stage-1 Norwood-type palliation (NP) compared with the modified Blalock–Taussig shunt.
METHODS
Consecutive patients who underwent NP between 2003 and 2019 were enrolled. SV–PA shunts using the expanded polytetrafluoroethylene valved conduit were implanted in 18 patients (valved SV–PA group), and another 18 patients underwent modified Blalock–Taussig shunt during NP (modified Blalock–Taussig shunt group). All valved conduits were made in our institution in advance.
RESULTS
No differences in baseline characteristics were found between the groups, except for shunt size. During a median 2.9 (interquartile range 0.4–6.4, maximum 14.2) years of follow-up, 8 (22.2%) patients died across both groups. There were no statistically significant differences in early mortality (5.5% vs 11.1%, P = 0.55) and overall survival rates at 5 years (80.8% vs 71.4%, P = 0.48) in the valved SV–PA and modified Blalock–Taussig shunt groups. No statistically significant difference was observed in the frequency of interventions between the groups (31% vs 33%, P = 1.0). At the time of the bidirectional Glenn procedure, the systemic ventricular end-diastolic volume index was significantly lower (84 ± 24 vs 106 ± 31 ml/m2, P = 0.05) and the ejection fraction was significantly greater (62 ± 8% vs 55 ± 9%, P = 0.03) in the valved SV–PA group. There was no statistically significant difference in the pulmonary artery index (228 ± 85 vs 226 ± 60 mm2/m2, P = 0.92).
CONCLUSIONS
A valved SV–PA shunt using an expanded polytetrafluoroethylene valved conduit was associated with preserved ventricular function after NP and did not impair pulmonary artery growth by controlling pulmonary regurgitation.
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Affiliation(s)
- Shuhei Fujita
- Department of Pediatric Cardiovascular Surgery, Children’s Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masaaki Yamagishi
- Department of Pediatric Cardiovascular Surgery, Children’s Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yoshinobu Maeda
- Department of Pediatric Cardiovascular Surgery, Children’s Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Keiichi Itatani
- Division of Cardiovascular Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Satoshi Asada
- Department of Pediatric Cardiovascular Surgery, Children’s Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hisayuki Hongu
- Department of Pediatric Cardiovascular Surgery, Children’s Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Eijiro Yamashita
- Department of Pediatric Cardiovascular Surgery, Children’s Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yuji Takayanagi
- Department of Pediatric Cardiovascular Surgery, Children’s Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hiroki Nakatsuji
- Department of Pediatric Cardiovascular Surgery, Children’s Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hitoshi Yaku
- Division of Cardiovascular Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Nasirov T, Maeda K, Reinhartz O. Aortic or Pulmonary Valved Homograft Right Ventricle to Pulmonary Artery Conduit in the Norwood Procedure. World J Pediatr Congenit Heart Surg 2019; 10:499-501. [PMID: 31307304 DOI: 10.1177/2150135119842865] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Several modifications of the Norwood procedure utilizing valved right ventricle to pulmonary artery conduits have recently been reported. Our group has been using aortic or pulmonary valved homografts combined with PTFE tube grafts for now 16 years. METHODS In this report, we review our technique in detail and describe any changes that have occurred over the years. We provide detailed illustrations of our preferred surgical technique, report outcome data, and compare it to the other conduit options available. RESULTS Between 2006 and 2015, 130 stage I Norwood procedures were performed at our institution, 100 of them using valved conduits. Our technique is described and illustrated in detail. Early mortality was 15%. Postoperative percutaneous intervention on the conduit was required in 29% of cases. CONCLUSIONS While a randomized trial comparing different valved conduits is lacking, we believe a composite conduit made from homograft aortic or pulmonary valves and PTFE tube grafts is an excellent choice in stage I Norwood procedure.
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Affiliation(s)
- Teimour Nasirov
- 1 Department of Cardiothoracic Surgery, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Katsuhide Maeda
- 1 Department of Cardiothoracic Surgery, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Olaf Reinhartz
- 1 Department of Cardiothoracic Surgery, Stanford University School of Medicine, Palo Alto, CA, USA
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Kumar TKS, Zurakowski D, Briceno-Medina M, Shah A, Sathanandam S, Allen J, Sandhu H, Joshi VM, Boston U, Knott-Craig CJ. Experience of a single institution with femoral vein homograft as right ventricle to pulmonary artery conduit in stage 1 Norwood operation. J Thorac Cardiovasc Surg 2019; 158:853-862.e1. [PMID: 31204139 DOI: 10.1016/j.jtcvs.2019.03.123] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 02/21/2019] [Accepted: 03/06/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Femoral vein homograft can be used be used as valved right ventricle to pulmonary artery conduit in the Norwood operation. We describe the results of this approach, including pulmonary artery growth and ventricular function. METHODS A retrospective chart review of 24 consecutive neonates with hypoplastic left heart syndrome or complex single ventricle undergoing this approach between June 2012 and December 2017 was performed. Conduit valve competency and ventricular function were estimated using transthoracic echocardiogram, and pulmonary artery growth was measured using Nakata's index. Changes in ventricular function pre-Glenn and at latest follow-up were assessed by ordinal logistic regression with a general linear model to account for the correlation within the same patient over time. RESULTS Median age at surgery was 4 days, and mean weight was 3 kg. There was no interstage mortality. A total of 21 patients have undergone Glenn operation, and 9 patients have completed the Fontan operation. None of the conduits developed thrombosis. Sixty-three percent of conduits remained competent in the first month, and 33% remained competent after 3 months of operation. Catheter interventions on conduits were necessary in 14 patients. Median Nakata index at pre-Glenn catheterization was 228 mm2/m2 (interquartile range, 107-341 mm2/m2). Right ventricular function was preserved in 83% of patients at a median follow-up of 34 (interquartile range, 10-46) months. CONCLUSIONS Femoral vein homograft as a right ventricle to pulmonary artery conduit in the Norwood operation is safe and associated with good pulmonary artery growth and preserved ventricular function as assessed by subjective echocardiography. Catheter intervention of the conduit may be necessary.
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Affiliation(s)
- T K Susheel Kumar
- Department of Pediatric Cardiothoracic Surgery, Le Bonheur Children's Hospital and University of Tennessee Health Science Center, Memphis, Tenn.
| | - David Zurakowski
- Departments of Anesthesiology and Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | - Mario Briceno-Medina
- Department of Pediatric Cardiology, Le Bonheur Children's Hospital and University of Tennessee Health Science Center, Memphis, Tenn
| | - Aditya Shah
- Department of Pediatric Cardiothoracic Surgery, Le Bonheur Children's Hospital and University of Tennessee Health Science Center, Memphis, Tenn
| | - Shyam Sathanandam
- Department of Pediatric Cardiology, Le Bonheur Children's Hospital and University of Tennessee Health Science Center, Memphis, Tenn
| | - Jerry Allen
- Department of Pediatric Cardiothoracic Surgery, Le Bonheur Children's Hospital and University of Tennessee Health Science Center, Memphis, Tenn
| | - Hitesh Sandhu
- Department of Pediatric Cardiology, Le Bonheur Children's Hospital and University of Tennessee Health Science Center, Memphis, Tenn
| | - Vijaya M Joshi
- Department of Pediatric Cardiology, Le Bonheur Children's Hospital and University of Tennessee Health Science Center, Memphis, Tenn
| | - Umar Boston
- Department of Pediatric Cardiothoracic Surgery, Le Bonheur Children's Hospital and University of Tennessee Health Science Center, Memphis, Tenn
| | - Christopher J Knott-Craig
- Department of Pediatric Cardiothoracic Surgery, Le Bonheur Children's Hospital and University of Tennessee Health Science Center, Memphis, Tenn
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Mosca RS. Commentary: The Achilles' heel of the stage 1 palliation. J Thorac Cardiovasc Surg 2019; 158:863-864. [PMID: 31160107 DOI: 10.1016/j.jtcvs.2019.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 04/09/2019] [Indexed: 11/25/2022]
Affiliation(s)
- Ralph S Mosca
- Department of Cardiothoracic Surgery, NYU Langone Medical Center, New York, NY.
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Kalfa D. Commentary: To valve, or not to valve-That is the stage I question. J Thorac Cardiovasc Surg 2019; 158:865-866. [PMID: 31101349 DOI: 10.1016/j.jtcvs.2019.03.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 03/26/2019] [Indexed: 10/26/2022]
Affiliation(s)
- David Kalfa
- Section of Pediatric and Congenital Cardiac Surgery, Division of Cardiac, Thoracic and Vascular Surgery, NewYork-Presbyterian Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, NY.
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8
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Meyer DB, Nguyen K. Modified Distal Dunk Technique for Right Ventricle to Pulmonary Artery Shunt in Stage 1 Palliation. Ann Thorac Surg 2019; 107:e431-e433. [PMID: 30684480 DOI: 10.1016/j.athoracsur.2018.12.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 12/10/2018] [Accepted: 12/12/2018] [Indexed: 10/27/2022]
Abstract
Although the use of a right ventricle to pulmonary artery shunt as a source of pulmonary blood flow in stage 1 Norwood palliation is common, there is no uniform agreement on the optimal surgical technique. We present a technique for creating the distal connection aimed at minimizing procedural bleeding, promoting distal patency, and facilitating second-stage palliation.
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Affiliation(s)
- David B Meyer
- Division of Cardiothoracic Surgery, Cohen Children's Medical Center, Northwell Health System, Zucker Hofstra School of Medicine, New Hyde Park, New York.
| | - Khanh Nguyen
- Division of Cardiothoracic Surgery, Westchester Medical Center, New York Medical College, Valhalla, New York
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9
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Bichell D. Composite polytetrafluoroethylene homograft with external stent as valved pulmonary conduit: All hat and no cattle? J Thorac Cardiovasc Surg 2018; 157:351-352. [PMID: 30557951 DOI: 10.1016/j.jtcvs.2018.09.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Accepted: 09/17/2018] [Indexed: 10/28/2022]
Affiliation(s)
- David Bichell
- Department of Cardiac Surgery, Monroe Carell, Jr Children's Hospital, Vanderbilt University Medical Center, Nashville, Tenn.
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10
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Hoganson DM, Cigarroa CL, van den Bosch SJ, Sleeper LA, Callahan R, Friedman KG, Baird CW, Quinonez LG, Kaza AK, Emani SE, Kheir JN. Impact of a Composite Valved RV-PA Graft After Stage 1 Palliation. Ann Thorac Surg 2018; 106:1452-1459. [PMID: 29964021 DOI: 10.1016/j.athoracsur.2018.05.068] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 05/15/2018] [Accepted: 05/25/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND The use of a valved right ventricular to pulmonary artery shunt (RVPAS) has been reported by some to improve pulmonary artery growth after stage 1 palliation (S1P). METHODS We retrospectively reviewed all patients undergoing an S1P with an RVPAS between January 2013 and May 2017, stratified by RVPAS type: a ring-reinforced polytetrafluoroethylene (PTFE) graft or a composite graft that included a distal valved femoral or saphenous vein homograft. We examined the association of RVPAS type on postoperative hemodynamics, time to reintervention, pulmonary artery growth, and survival. RESULTS Among 94 infants, 56 (60%) underwent PTFE-only shunt, 24 (25%) underwent femoral vein homograft, and 14 (15%) underwent saphenous vein homograft, and no relevant risk factor differences were found between the groups. Arterial saturation was 2.3% higher (p = 0.014) and serum lactic acid was 1.24 mg/dL lower (p = 0.03) in the femoral vein homograft group than in the PTFE-only group, although venous saturation was similar. By 60 days, 50% of patients with saphenous vein homograft had a reintervention compared with 5% with PTFE graft (p < 0.0001) and 12% with femoral vein homograft (p = 0.2 versus PTFE). At the time of stage 2 palliation, no differences were found in pulmonary artery size or growth over time by either echocardiogram or angiography or in the density of aortopulmonary collaterals or degree of tricuspid regurgitation. The 12-month survival was similar between the groups. CONCLUSIONS The use of an interposition femoral vein homograft into the RVPAS may enhance perioperative stability, but it does not substantially improve interstage growth of the pulmonary arteries. Use of saphenous vein homograft is associated with earlier time to reintervention after S1P.
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Affiliation(s)
- David M Hoganson
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, Massachusetts; Department of Surgery, Harvard Medical School, Boston, Massachusetts
| | - Claire L Cigarroa
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | | | - Lynn A Sleeper
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Ryan Callahan
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Kevin G Friedman
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Christopher W Baird
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, Massachusetts; Department of Surgery, Harvard Medical School, Boston, Massachusetts
| | - Luis G Quinonez
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, Massachusetts; Department of Surgery, Harvard Medical School, Boston, Massachusetts
| | - Aditya K Kaza
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, Massachusetts; Department of Surgery, Harvard Medical School, Boston, Massachusetts
| | - Sitaram E Emani
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, Massachusetts; Department of Surgery, Harvard Medical School, Boston, Massachusetts
| | - John N Kheir
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
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Said SM, Dearani JA. Norwood valved Sano shunt: Early reward versus late penalty? J Thorac Cardiovasc Surg 2018; 155:1756-1757. [PMID: 29370912 DOI: 10.1016/j.jtcvs.2017.12.114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 12/20/2017] [Indexed: 11/25/2022]
Affiliation(s)
- Sameh M Said
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn
| | - Joseph A Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn.
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12
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Burkhart HM, Mir A, Thompson JL. Hypoplastic left heart syndrome and the allure of a valved conduit. J Thorac Cardiovasc Surg 2018; 155:1745-1746. [PMID: 29370913 DOI: 10.1016/j.jtcvs.2017.12.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 12/18/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Harold M Burkhart
- Division of Cardiovascular and Thoracic Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, Okla.
| | - Arshid Mir
- Section of Pediatric Cardiology, University of Oklahoma Health Sciences Center, Oklahoma City, Okla
| | - Jess L Thompson
- Division of Cardiovascular and Thoracic Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, Okla
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