Faculty Collaboration Database

Outcomes of systemic to pulmonary artery shunts in patients weighing less than 3 kg: analysis of shunt type, size, and surgical approach. J Thorac Cardiovasc Surg 2014 Feb;147(2):672-7

Date

11/21/2013

Pubmed ID

24252942

DOI

10.1016/j.jtcvs.2013.09.055

Scopus ID

2-s2.0-84892369049 (requires institutional sign-in at Scopus site)   53 Citations

Abstract

OBJECTIVE: To evaluate outcomes of systemic to pulmonary artery shunts (SPS) in patients weighing less than 3 kg with regard to shunt type, shunt size, and surgical approach.

METHODS: Patients weighing less than 3 kg who underwent modified Blalock-Taussig or central shunts with polytetrafluoroethylene grafts at our institution from January 1, 2000, to May 31, 2011, were reviewed. Patients who had undergone other major concomitant procedures were excluded from the analysis. Primary outcomes included mortality (discharge mortality and mortality before next planned palliative procedure or definitive repair), cardiac arrest and/or extracorporeal membrane oxygenation (ECMO), and shunt reintervention.

RESULTS: In this cohort of 80 patients, discharge survival was 96% (77/80). Postoperative cardiac arrest or ECMO occurred in 6/80 (7.5%), and shunt reintervention was required in 14/80 (17%). On univariate analysis, shunt reintervention was more common in patients with 3-mm shunts (11/30, 37%) compared with 3.5-mm (2/36, 6%) or 4-mm shunts (1/14, 7%) (P < .003). There were no statistically significant associations between shunt type, shunt size, or surgical approach and cardiac arrest/ECMO or mortality. Multiple logistic regression demonstrated that a shunt size of 3 mm (P = .019) and extracardiac anomaly (P = .047) were associated with shunt reintervention, whereas no variable was associated with cardiac arrest/ECMO or mortality.

CONCLUSIONS: In this high-risk group of neonates weighing less than 3 kg at the time of SPS, survival to discharge and the next planned surgical procedure was high. Outcomes were good with the 3.5- and 4-mm shunts; however, shunt reintervention was common with 3-mm shunts.

Author List

Myers JW, Ghanayem NS, Cao Y, Simpson P, Trapp K, Mitchell ME, Tweddell JS, Woods RK

Authors

Michael Edward Mitchell MD Chief, Professor in the Surgery department at Medical College of Wisconsin
Pippa M. Simpson PhD Adjunct Professor in the Pediatrics department at Medical College of Wisconsin
Ronald K. Woods MD Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Blalock-Taussig Procedure
Blood Vessel Prosthesis
Body Weight
Chi-Square Distribution
Extracorporeal Membrane Oxygenation
Heart Defects, Congenital
Hospital Mortality
Humans
Infant
Infant, Newborn
Kaplan-Meier Estimate
Logistic Models
Polytetrafluoroethylene
Postoperative Complications
Prosthesis Design
Pulmonary Artery
Pulmonary Circulation
Reoperation
Retrospective Studies
Risk Factors
Time Factors
Treatment Outcome