HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Osama Benhameid Andrew Campbell Suvro Sett Jacques Le Blanc Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Mohammadi, S. Articles by Le Blanc, J. Search for Related Content PubMed Articles by Mohammadi, S. Articles by Le Blanc, J. Related Collections Congenital - cyanotic

Could we still improve early and interim outcome after prosthetic systemic-pulmonary shunt? A risk factors analysis

Department of Pediatric Cardiac Surgery, British Columbia Children's Hospital, Vancouver, BC, Canada

Received 28 December 2007; received in revised form 27 May 2008; accepted 2 June 2008.

^_* Corresponding author. Address: McGill University Health Center, Cardiac Surgery Department, 687 Pine Avenue West, Montreal, QC, Canada H3A 1A1. Tel.: +1 514 843 1463; fax: +1 514 843 1602. (Email: siamakmohammadi{at}yahoo.com).

Objective: To identify factors associated with in-hospital and interim mortality in children with a systemic-to-pulmonary shunt (SPS). Methods: Between January 1988 and April 2005, 226 children with a median age of 17 days, and weight of 3.4 kg, underwent an isolated SPS for pulmonary atresia (PA)-VSD/ tetralogy (n = 124, 54.9%), functional single ventricle PA (n = 35, 5.5%), PA-intact septum (IS, n = 31, 13.7%), transposition of the great arteries VSD-PA (n = 30, 13.3%), and double outlet right ventricle-PA (n = 6, 2.6%). Surgery was performed through sternotomy (group S, n = 46) or thoracotomy (group T, n = 180). The origin of the SPS was either the innominate artery (n = 38) or ascending aorta (n = 8) in group S, and the subclavian artery (n = 180) in group T. Results: In-hospital mortality was 5.7%. Univariate and logistic regression analysis revealed younger age (p = 0.01), lower body weight (p < 0.04), a diagnosis of PA-IS with severe right ventricle hypoplasia (p = 0.005), preoperative intubation (p = 0.03), increased length of intubation (p < 0.0001), longer ICU stay (p < 0.0001), and group S (p = 0.03) as risk factors for in-hospital death. Group S had a longer median ventilation time (112 vs 30 h, p < 0.0001) despite the similar median age, weight, mean indexed shunt size (1.19 vs 1.15 mm/kg, p = 0.2), and the number of patients with antegrade pulmonary flow. Interim mortality was 7% (n = 15), and younger age (p = 0.03), and group T (p = 0.03) were independent risk factors for death prior to second-stage surgery. Absence of antiplatelet agents or anticoagulants was not a risk factor for interim mortality. Conclusions: In-hospital mortality and longer ventilation time after SPS by sternotomy may be related to pulmonary over circulation due to shunt insertion origin and/or size, and pathologic features. Early and interim outcomes can be improved by using a smaller shunt or changing the SPS insertion origin when using a sternotomy approach.

Key Words: Systemic-pulmonary shunt • Pulmonary atresia • Pulmonary blood flow