Bovine Mesenteric Venous Graft as an Alternative Conduit in Patients with Cyanotic Heart Disease with E-Polytetrafluoroethylene Graft Failure Caused by Thrombophilic Factor Positivity after Modified Blalock-Taussig Shunt
AbstractModified Blalock-Taussig shunt (MBTS) is a palliative operation for cyanotic congenital heart disease (CCHD) in patients for whom total correction is not appropriate. Many synthetic or biologic grafts have been proposed as alternative shunt materials. The use of a bovine mesenteric venous graft (BMVG) as a systemic-to-pulmonary artery shunt conduit without the administration of antiaggregant and anticoagulant has been proposed as a treatment for neonates with CCHD, but few reports address the importance of thrombophilic risk factors in MBTS and bovine venous graft as a shunt material. We used BMVG as a shunt material without any antiaggregant or antiplatelet regimen in 13 patients with CCHD, all of whom were candidates for MBTS and had thrombophilic risk factors assessed in our initial study. Early shunt failure occurred in the first 3 patients and was attributed to less surgical experience with this graft. No complications were attributable to graft material or surgery itself. In all cases functioning MBTSs were observed on follow-up. Our study results show that thrombophilic factors should be evaluated before the MBTS procedure. BMVG could be the choice of graft for use without the administration of antiaggregant and anticoagulants in patients with thrombophilic risk factors.
Bove EL, Kohman L, Sereika S, et al. 1997. The modified Blalock-Taussig shunt: analysis of adequacy and duration of palliation. Circulation 76(Suppl 3):19-23.nCobanoglu A, Abbruzzese P, Brauner D, Ferre B, Issenberg H, Starr A. 1984. Therapeutic considerations in congenital absence of the right pulmonary artery. Use of internal mammary artery as a preparatory shunt. J Cardiovasc Surg 25:241-5.nDogan OF, Duman U, Karagoz T, Ozkutlu S, Ersoy U. 2005. Diagnosis of perigraft seroma formation by use of echocardiography after modified Blalock-Taussig shunt. Eur J Echocardiogr 6:385-7.nFenton KN, Siewers RD, Rebovich B, Pigula FA. 2003. Interim mortality in infants with systemic to pulmonary artery shunts. Ann Thorac Surg 76:152-7.nFermanis GG, Ekangaki AK, Salmon AP, et al. 1992. Twelve year experience with the modified Blalock-Taussig shunt in neonates. Eur J Cardiothorac Surg 6:586-9.nGladman G, McCrindle BW, Williams WG, Freedom RM, Benson LN. 1997. The modified Blalock-Taussig shunt: clinical impact and morbidity in Fallot's tetralogy in the current era. J Thorac Cardiovasc Surg 114:25-30.nGlickman MH, Lawson JH, Katzman HE, Schild AF, Fujitani RM. 2004. Challenges of hemodialysis access for high risk patients: Impact of mesenteric vein bioprosthetic graft. J Vasc Access 4:73-80.nHatzibaloglu A, Velissaris I, Kaitzis D, Grakas D, Avdelidou A, Kiskinis D. 2004. ProCol vascular bioprosthesis for vascular access: Midterm results. J Vasc Access 5:16-8.nKalangos A, Beghetti M, Pache JC, Vala D, Faidutti B. 2001. Systemic to pulmonary artery shunt using a bovine mesenteric venous graft in newborns. J Card Surg 15:239-43.nKatzman HE, Glickman MH, Schild AF, Fujitani RM, Lawson JH. 2005. Multicenter evaluation of the bovine mesenteric vein bioprostheses for hemodialysis access in patients with an earlier failed prosthetic graft. J Am Coll Surg 201(2):223-30.nLeao LEV, Andrade JCS, Succi J, et al. 1985. Modified Blalock-Taussig shunt with an umbilical vein graft. Tex Heart Inst J 12(1):65-71.nMalm TK, Holmqvist C, Olsson CG, et al. 1998. Successful thrombolysis of an occluded modified Blalock-Taussig shunt three days after operation. Ann Thorac Surg 65:1453-5.nMotz R, Wessel A, Ruschewski W, Bürsch J. 1999. Reduced frequency of occlusion of aorto-pulmonary shunts in infants receiving aspirin. Cardiol Young 9:474-7.nSchmidli J, Savolainen H, Heller G, et al. 2004. Bovine mesenteric vein graft (ProCol) in critical limb ischaemia with tissue loss and infection. Eur J Vasc Endovasc Surg 27(3):251-3.nSivakumar K, Anil SR, Ravichandra M, Natarajan KU, Kamath P, Kumar RK. 2001. Emergency transcatheter balloon recanalization of acutely thrombosed modified Blalock-Taussig shunts. Indian Heart J 53(6):743-8.nTam VKH, Murphy K, Parks WJ, et al. 2001. Saphenous Vein Homograft: A Superior Conduit for the Systemic Arterial Shunt in the Norwood Operation. Ann Thorac Surg 71:1537-40.nTomizawa Y, Takanashi Y, Noishiki Y, et al. 1998. Evaluation of small caliber vascular prostheses implanted in small children: activated angiogenesis and accelerated calcification. ASAIO J 44:M496-500.nTsai KT, Chang CH, Lin PJ. 1996. Modified Blalock-Taussig shunt: statistical analysis of potential factors influencing shunt outcome. J Thorac Cardiovasc Surg 37:149-52.nAkbulut B, Dogan R, Demircin M, et al. 2005. Thrombophilic factors: do they have a role in modified Blalock-Taussig shunt thrombosis? Interactive Cardiovasc Thorac Surg 4(Suppl 1):P13-14.nAl Jubair KA, Al Fagih MR, Al Jarallah AS, et al. 1998. Results of 546 Blalock-Taussig shunts performed in 478 patients. Cardiol Young 8:486-90.n
How to Cite
Author Disclosure & Copyright Transfer Agreement
In order to publish the original work of another person(s), The Heart Surgery Forum® must receive an acknowledgment of the Author Agreement and Copyright Transfer Statement transferring to Forum Multimedia Publishing, L.L.C., a subsidiary of Carden Jennings Publishing Co., Ltd. the exclusive rights to print and distribute the author(s) work in all media forms. Failure to check Copyright Transfer agreement box below will delay publication of the manuscript.
A current form follows:
The author(s) hereby transfer(s), assign(s), or otherwise convey(s) all copyright ownership of the manuscript submitted to Forum Multimedia Publishing, LLC (Publisher). The copyright transfer covers the exclusive rights to reproduce and distribute the article and the material contained therein throughout the world in all languages and in all media of expression now known or later developed, including but not limited to reprints, photographic reproduction, microfilm, electronic data processing (including programming, storage, and transmission to other electronic data record(s), or any other reproductions of similar nature), and translations.
However, Publisher grants back to the author(s) the following:
- The right to make and distribute copies of all or part of this work for use of the author(s) in teaching;
- The right to use, after publication in The Heart Surgery Forum, all or part of the material from this work in a book by the author(s), or in a collection of work by the author(s);
- The royalty-free right to make copies of this work for internal distribution within the institution/company that employs the author(s) subject to the provisions below for a work-made-for-hire;
- The right to use figures and tables from this work, and up to 250 words of text, for any purpose;
- The right to make oral presentations of material from this work.
Publisher reserves the right to grant or refuse permission to third parties to republish all or part of the article or translations thereof. To republish, such third parties must obtain written permission from the Publisher. (This is in accordance with the Copyright Statute, United States Code, Title 17. Exception: If all authors were bona fide officers or employees of the U.S. Government at the time the paper was prepared, the work is a “work of the US Government” (prepared by an officer or employee of the US Government as part of official duties), and therefore is not subject to US copyright; such exception should be indicated on signature lines. If this work was prepared under US Government contract or grant, the US Government may reproduce, royalty-free, all or portions of this work and may authorize others to do so, for official US Government purposes only, if the US Government contract or grant so requires.
I have participated in the conception and design of this work and in the writing of the manuscript and take public responsibility for it. Neither this manuscript nor one with substantially similar content under my authorship has been published, has been submitted for publication elsewhere, or will be submitted for publication elsewhere while under consideration by The Heart Surgery Forum, except as described in an attachment. I have reviewed this manuscript (original version) and approve its submission. If I am listed above as corresponding author, I will provide all authors with information regarding this manuscript and will obtain their approval before submitting any revision. I attest to the validity, accuracy, and legitimacy of the content of the manuscript and understand that Publisher assumes no responsibility for the validity, accuracy, and legitimacy of its content. I warrant that this manuscript is original with me and that I have full power to make this Agreement. I warrant that it contains no matter that is libelous or otherwise unlawful or that invades individual privacy or infringes any copyright or other proprietary right. I agree to indemnify and hold Publisher harmless of and from any claim made against Publisher that relates to or arises out of the publication of the manuscript and agree that this indemnification shall include payment of all costs and expenses relating to the defense of any such claim, including all reasonable attorney’s fees.
I warrant that I have no financial interest in the drugs, devices, or procedures described in the manuscript (except as disclosed in the attached statement).
I state that the institutional Human Subjects Committee and/or the Ethics Committee approved the clinical protocol reported in this manuscript for the use of experimental techniques, drugs, or devices in human subjects and appropriate informed consent documents were utilized.
Furthermore, I state that any and all animals used for experimental purposes received humane care in USDA registered facilities in compliance with the “Principles of Laboratory Animal Care” formulated by the National Society for Medical Research and the “Guide for the Care and Use of Laboratory Animals” prepared by the Institute of Laboratory Animal Resources and published by the National Institutes of Health (NIH Publication No. 85-23, revised 1985).