Thorac cardiovasc Surg 2019; 67(01): 002-007
DOI: 10.1055/s-0037-1621706
Original Cardiovascular
Georg Thieme Verlag KG Stuttgart · New York

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

Keti Vitanova
1  Department of Cardiovascular Surgery, German Heart Centre Munich, Technische Universität München, Munich, Germany
2  Insure (Institute for Translational Cardiac Surgery), Department of Cardiovascular Surgery, German Heart Centre Munich, Technische Universität München, Munich Germany
,
Cornelius Leopold
1  Department of Cardiovascular Surgery, German Heart Centre Munich, Technische Universität München, Munich, Germany
2  Insure (Institute for Translational Cardiac Surgery), Department of Cardiovascular Surgery, German Heart Centre Munich, Technische Universität München, Munich Germany
,
Jelena Pabst von Ohain
1  Department of Cardiovascular Surgery, German Heart Centre Munich, Technische Universität München, Munich, Germany
2  Insure (Institute for Translational Cardiac Surgery), Department of Cardiovascular Surgery, German Heart Centre Munich, Technische Universität München, Munich Germany
,
Cordula Wolf
3  Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Centre Munich, Technische Universität München, Germany
,
Elisabeth Beran
1  Department of Cardiovascular Surgery, German Heart Centre Munich, Technische Universität München, Munich, Germany
2  Insure (Institute for Translational Cardiac Surgery), Department of Cardiovascular Surgery, German Heart Centre Munich, Technische Universität München, Munich Germany
,
Rüdiger Lange
1  Department of Cardiovascular Surgery, German Heart Centre Munich, Technische Universität München, Munich, Germany
2  Insure (Institute for Translational Cardiac Surgery), Department of Cardiovascular Surgery, German Heart Centre Munich, Technische Universität München, Munich Germany
4  German Heart Center Munich - DZHK Partner Site Munich Heart Alliance, Munich, Germany
,
Julie Cleuziou
1  Department of Cardiovascular Surgery, German Heart Centre Munich, Technische Universität München, Munich, Germany
2  Insure (Institute for Translational Cardiac Surgery), Department of Cardiovascular Surgery, German Heart Centre Munich, Technische Universität München, Munich Germany
› Author Affiliations
Further Information

Publication History

03 November 2017

13 December 2017

Publication Date:
19 January 2018 (eFirst)

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.

Note

Presented at 46th Annual Meeting of DGTHG, 11.-14.02.2017 in Leipzig, Germany