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
DOI:
https://doi.org/10.1532/HSF98.20071064Abstract
Modified 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.References
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
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