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J Thorac Cardiovasc Surg 2007;134:819
© 2007 The American Association for Thoracic Surgery

Letter to the Editor

Bovine jugular vein as aortic enlargement patch in the Norwood procedure

Mariano Vicchio, MD, Alessandro Nava, MD, Giuseppe Caianiello, MD

Department of Cardiothoracic Sciences, Second University of Naples, Naples, Italy

To the Editor:

We have read with interest the brief communication by Healy and colleagues,1Go in which they describe a new and innovative technique, never before published, concerning use of a bovine jugular vein as an augmentation patch in the Norwood procedure.

The original technique described by Norwood, Lang, and Hansen2Go involved the use of a homograft to enlarge the aorta. The lack of availability, its high cost, and the risk of infection induced some surgeons to use alternative patches. In fact, in 1999 Gargiulo and associates3Go described aortic augmentation with a bovine pericardial patch.

We were very enthusiastic about the Healy report in the Journal, both for its contribution to the research toward new alternative materials with respect to homografts in the Norwood procedure and because this technique is similar to our recent surgical strategy.

In 23 Norwood cases, we have used a Contegra patch (Medtronic, Inc, St Paul, Minn) to enlarge the aorta. Technically, we remove the jugular vein with the valve in it and we open the Contegra patch to perform aortic enlargement. The operative technique is not more complex than the original technique with the homograft. Our results were very fulfilling and were similar to these described in the literature with the classic Norwood operation. We prefer to use this conduit to reduce the risk of viral transmission and especially to reduce the risk of immunologic sensitization, as been described by Meyer and associates.4Go Besides these benefits, the cost is lower.

We hope that our positive experience can bring a little support to the Haley experience and technique.

References

  1. Healy DG, Nolke L, Wood AE. Bovine jugular vein as a shaped alternative patch material for aortic augmentation in the Norwood procedure. J Thorac Cardiovasc Surg. 2007;133:567-568.[Free Full Text]
  2. Norwood WI, Lang P, Hansen DD. Physiologic repair of aortic atresia–hypoplastic left heart syndrome. N Engl J Med. 1983;308:23-26.[Medline]
  3. Gargiulo G, Napoleone CP, Solinas M, Frascaroli G, Pierangeli A. A new patch for the Norwood procedure. Ann Thorac Surg. 1999;68:1873-1874.[Abstract/Free Full Text]
  4. Meyer SR, Campbell PM, Rutledge JM, Halpin AM, Hawkins LE, Lakey JR, et al. Use of an allograft patch in repair of hypoplastic left heart syndrome may complicate future transplantation. Eur J Cardiothorac Surg. 2005;27:554-560.[Abstract/Free Full Text]




This Article
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Right arrow Author home page(s):
Mariano Vicchio
Giuseppe Caianiello
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Right arrow Articles by Vicchio, M.
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Right arrow Articles by Vicchio, M.
Right arrow Articles by Caianiello, G.
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Right arrow Congenital - acyanotic
Right arrow Great vessels

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