Association Between Venous Homografts and Allosensitization After Norwood Procedure.

Autor:	Tan CH; Division of Pediatric Cardiology, 9967University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA., Cleveland DC; Division of Cardiothoracic Surgery, Section of Pediatric Cardiac Surgery, 9967University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA., Dabal RJ; Division of Cardiothoracic Surgery, Section of Pediatric Cardiac Surgery, 9967University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA., Padilla LA; Division of Cardiothoracic Surgery, Section of Pediatric Cardiac Surgery, 9967University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA., Maxwell KS; Division of Cardiothoracic Surgery, Section of Pediatric Cardiac Surgery, 9967University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA., Law MA; Division of Pediatric Cardiology, 9967University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA., Carlo WF; Division of Pediatric Cardiology, 9967University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA., Borasino S; Division of Pediatric Cardiology, Section of Cardiac Critical Care Medicine, 9967University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA., Sorabella RA; Division of Cardiothoracic Surgery, Section of Pediatric Cardiac Surgery, 9967University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA.
Jazyk:	angličtina
Zdroj:	World journal for pediatric & congenital heart surgery [World J Pediatr Congenit Heart Surg] 2023 Jan; Vol. 14 (1), pp. 25-30.
DOI:	10.1177/21501351221120411
Abstrakt:	Background: Right ventricle (RV) to pulmonary artery (PA) shunts have become the shunt of choice at many centers for use during the Norwood procedure for single ventricle palliation. Some centers have begun to use cryopreserved femoral or saphenous venous homografts as an alternative to polytetrafluoroethylene (PTFE) for shunt construction. The immunogenicity of these homografts is unknown, and potential allosensitization could have significant implications on transplant candidacy. Methods: All patients undergoing Glenn procedure at our center between 2013 and 2020 were screened. Patients who initially underwent Norwood procedure with either PTFE or venous homograft RV-PA shunt and had available pre-Glenn serum were included in the study. The primary outcome of interest was panel reactive antibody (PRA) level at the time of Glenn surgery. Results: Thirty-six patients met inclusion criteria (N = 28 PTFE, N = 8 homograft). Patients in the homograft group had significantly higher median PRA levels at the time of Glenn surgery (0% [IQR 0-18] PTFE vs 94% [IQR 74-100] homograft, P  = .003). There were no other differences between the two groups. Conclusions: Despite potential improvements in PA architecture, the use of venous homografts for RV-PA shunt construction at the time of Norwood procedure is associated with significantly elevated PRA level at the time of Glenn surgery. Centers should carefully consider the use of currently available venous homografts given the high percentage of these patients who may require future transplantation.
Databáze:	MEDLINE
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