Early systemic-to-pulmonary artery shunt intervention in neonates with congenital heart disease

Objective To determine the incidence, risk factors, and outcomes after early, unplanned intervention on systemic-to-pulmonary artery shunts in neonates. Methods We retrospectively studied all neonates undergoing systemic-to-pulmonary artery shunt placement at The Children’s Hospital of Philadelphia...

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Bibliographic Details
Published in:The Journal of thoracic and cardiovascular surgery 2011-07, Vol.142 (1), p.106-112
Main Authors: O’Connor, Matthew J., MD, Ravishankar, Chitra, MD, Ballweg, Jean A., MD, Gillespie, Matthew J., MD, Gaynor, J. William, MD, Tabbutt, Sarah, MD, PhD, Dominguez, Troy E., MD
Format: Article
Language:English
Subjects:
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Biological and medical sciences
Blalock-Taussig Procedure - adverse effects
Blalock-Taussig Procedure - mortality
Cardiac Catheterization - adverse effects
Cardiac Catheterization - mortality
Cardiology. Vascular system
Cardiothoracic Surgery
Chi-Square Distribution
Communicable Diseases - etiology
Congenital heart diseases. Malformations of the aorta, pulmonary vessels and vena cava
Extracorporeal Membrane Oxygenation
Female
Heart
Heart Defects, Congenital - mortality
Heart Defects, Congenital - physiopathology
Heart Defects, Congenital - surgery
Hemodynamics
Hospital Mortality
Hospitals, Pediatric
Humans
Infant, Newborn
Kaplan-Meier Estimate
Length of Stay
Logistic Models
Male
Medical sciences
Philadelphia
Pneumology
Pulmonary Artery - physiopathology
Pulmonary Artery - surgery
Pulmonary Circulation
Reoperation
Retrospective Studies
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
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Summary:Objective To determine the incidence, risk factors, and outcomes after early, unplanned intervention on systemic-to-pulmonary artery shunts in neonates. Methods We retrospectively studied all neonates undergoing systemic-to-pulmonary artery shunt placement at The Children’s Hospital of Philadelphia between September 1, 2002, and May 1, 2005. Patients requiring transcatheter or surgical systemic-to-pulmonary artery shunt intervention before discharge were compared with those not undergoing shunt intervention. Results A total of 206 patients underwent shunt placement. Diagnoses included hypoplastic left heart syndrome (62.1%), pulmonary atresia (15%), tricuspid atresia (4.9%), tetralogy of Fallot (2.4%), and other lesions with obstruction to systemic (10.7%) or pulmonary blood flow (4.9%). Twenty-one interventions occurred in 20 patients (9.7%). Risk factors for intervention included heterotaxy syndrome ( P = . 04), congenital abnormality ( P = . 04), and a trend toward lower birthweight. In patients with a modified Blalock–Taussig shunt, similar risk factors were identified and the incidence of intervention decreased with increasing shunt size. In-hospital mortality was 30% (6/20) for the cases and 8.1% (15/186) for the nonintervention group ( P = . 02). Long-term survival was significantly lower in patients requiring intervention ( P = . 002). This group also had a higher incidence of infections ( P 
ISSN:0022-5223
1097-685X
DOI:10.1016/j.jtcvs.2010.10.033