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

Background. Excessive pulmonary blood flow increases ventricular volume wor k in the face of inadequate systemic cardiac output, low diastolic blood pr essure, and inadequate coronary perfusion. Using the smallest available 3-m m polytetrafluoroethylene shunts have been successful, although catastrophi c shunt thrombosis has occasionally been observed. To avoid thrombosis with a smaller conduit, saphenous Vein homografts [SVG) were used to construct the modified Blalock-Taussig (BT) shunts. Methods. From January 1998 to April 1999, 25 patients weighing 3.1 kg (3.0 kg or less, n = 9), at a mean age of 8.9 days, underwent stage I Norwood us ing an SVG BT shunt. Common heart defects were aortic atresia (n = 8), mitr al atresia and double-outlet right ventricle (n = 5), and unbalanced AVC (n = 5). Mean BT shunt size was 3.2 mm, with 12 patients having shunts that w ere 3 mm or smaller. Results. Thirty-day hospital mortality was 8% (2 of 25). No shunt thrombosi s was seen, despite banding the BT shunt in 3 patients. One patient had BT revision because of an anatomic issue not directly related to the shunt mat erial. Conclusions. Excellent results may be achieved using SVG BT shunts in the N orwood operation. This conduit seems less likely to thrombose, both acutely and chronically, allowing the use of appropriately smaller-sized shunts in small neonates. (Ann Thorac Surg 2001;71:1537-40) (C) 2001 by The Society of Thoracic Surgeons.