Outcomes of systemic to pulmonary artery shunts in patients weighing less than 3 kg: Analysis of shunt type, size, and surgical approach

Abstract

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.

Single Ventricle Palliation in Low Weight Patients Is Associated With Worse Early And Midterm Outcomes

“…Low weight has persistently been demonstrated as a risk factor for mortality after the Norwood operation, including in recent series from experienced institutions [11,12,14]. Similarly, low weight has been associated with increased mortality risk after BTS due to shunt occlusion related to the small sized shunts or systemic steal due to excessive pulmonary blood flow that is likely more common in smaller babies [16,17]. In a recent review of the Society of Thoracic Surgeons database, weight less than 3 kg at surgery was an independent risk factor for hospital mortality after BTS [16].…”

Results of Palliation With an Initial Modified Blalock-Taussig Shunt in Neonates With Single Ventricle Anomalies Associated With Restrictive Pulmonary Blood Flow

“…First-stage palliation of neonates born with SV and associated restricted pulmonary blood flow is one of the major indications for mBTS in the current era [1][2][3][4][5][6]. A recent report examining The Society of Thoracic Surgeons (STS) database showed that 62% of mBTS performed in the US were actually for cardiac anomalies that were amenable for eventual biventricular repair [2].…”

“…We were unable to identify risk factors for shunt revision in our series. A recent report from Milwaukee [3] showed that shunt reintervention was required in 17% of neonates after mBTS and identified shunt size 3.0 mm and extracardiac malformations as risk factors for reintervention. Another report, from Philadelphia [7], showed that shunt intervention was required in 9.7% of neonates after mBTS and identified heterotaxy syndrome, extracardiac malformations, and lower weight as risk factors for reintervention.…”

“…Advances in perioperative care, surgical and perfusion techniques have allowed early primary repair of many cardiac anomalies without the need for palliative shunts. Nonetheless, the use of mBTS continues to be required in several infants with biventricular cardiac anomalies who are not deemed to be candidates to receive early complex repair, and more importantly in neonates with various single ventricle (SV) anomalies associated with restricted pulmonary blood flow as the first surgery in the multistage palliation strategy of their SV anomaly [1][2][3][4][5][6]. Although the total number of infants who receive mBTS has decreased in the current era, the proportion of those with underlying SV cardiac anomalies has increased [1][2][3].…”

“…Despite several improvements in diagnosis, intervention, and early and late management of children with congenital heart disease, mBTS continues to be associated with high operative death, reintervention, and interstage mortality risks [2][3][4][5][6][7]. A recent study [2] that examined outcomes of neonates who received mBTS in the current era from The Society of Thoracic Surgeons (STS) database showed that operative mortality was 7.2%, with higher mortality seen in patients with SV or pulmonary atresia with intact ventricular septum (PAIVS).…”