Reasons for Failure of Systemic-to-Pulmonary Artery Shunts in Neonates.

Vitanova, Keti; Leopold, Cornelius; von Ohain, Jelena Pabst; Wolf, Cordula; Beran, Elisabeth; Lange, Rüdiger; Cleuziou, Julie

doi:10.1055/s-0037-1621706

2019

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Title:: Reasons for Failure of Systemic-to-Pulmonary Artery Shunts in Neonates.
Document type:: Journal Article
Author(s):: Vitanova, Keti; Leopold, Cornelius; von Ohain, Jelena Pabst; Wolf, Cordula; Beran, Elisabeth; Lange, Rüdiger; Cleuziou, Julie
Abstract:: BACKGROUND: Systemic-to-pulmonary artery shunt placement is an established palliative procedure for congenital heart disease. Although it is thought to be a simple operation, it is associated with significant morbidity and mortality. METHODS: Data for all neonates who underwent surgery for a systemic-to-pulmonary artery shunt between 2000 and 2016 were reviewed. The study endpoints were shunt failure and shunt-related mortality. Shunt failure was defined as a shunt dysfunction because of thrombosis or stenosis requiring intervention or reoperation; shunt mortality was defined as death because of a shunt dysfunction. RESULTS: A total of 305 shunts (central shunt, n = 135; Blalock-Taussig shunt, n = 170) were implanted in 280 patients. The median patients' age at the time of surgery was 9 days (1-31 days). The median shunt size was 3.5 mm (3-4 mm). Twenty-four patients (8%) were diagnosed with a shunt failure, with a median time of 7 days (0-438 days). Freedom from shunt failure at 1 year was 91.6% ± 2%. A shunt-related mortality was ascertained for 12 patients (4%). Freedom from shunt-related mortality at 1 year was 96% ± 1%. Perioperative platelet transfusion (p = 0.01), central shunt (p = 0.02), 3-mm shunt size (p = 0.02), and postoperative extra corporeal membrane oxygenation (ECMO) (p < 0.01) were identified as risk factors for shunt failure. Platelet transfusion (p = 0.04) and postoperative ECMO (p < 0.01) were further identified as risk factors for shunt mortality. CONCLUSION: Based on these data, we recommend implanting a modified Blalock-Taussig shunt of at least 3.5 mm in neonates. Perioperative platelet transfusion and postoperative ECMO increase the risk of shunt failure.
Journal title abbreviation:: Thorac Cardiovasc Surg
Year:: 2019
Journal volume:: 67
Journal issue:: 1
Pages contribution:: 2-7
Fulltext / DOI:: doi:10.1055/s-0037-1621706
Pubmed ID:: http://view.ncbi.nlm.nih.gov/pubmed/29351695
Print-ISSN:: 0171-6425
TUM Institution:: Klinik für Herz- und Gefäßchirurgie (Prof. Lange); Klinik für Kinderkardiologie und angeborene Herzfehler (Prof. Hess)
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mediaTUM Gesamtbestand Einrichtungen Schools TUM School of Medicine and Health Departments Clinical Medicine Lehr- und Forschungskooperationen mit den Kliniken und Instituten am Deutschen Herzzentrum Klinik für Herz- und Gefäßchirurgie (DHM) (Prof. Krane)2019

mediaTUM Gesamtbestand Einrichtungen Schools TUM School of Medicine and Health Departments Clinical Medicine Lehr- und Forschungskooperationen mit den Kliniken und Instituten am Deutschen Herzzentrum Klinik für Kinderkardiologie und angeborene Herzfehler (DHM) (Prof. Ewert)2019