Reduced frequency of occlusion of aorto-pulmonary shunts in infants receiving Aspirin

Motz, Reinald; Wessel, Armin; Ruschewski, W.; Bürsch, Jochen

doi:10.1017/s1047951100005370

Cited by 34 publications

(14 citation statements)

References 11 publications

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“…Centazzo et al 11 showed no difference in shunt patency index (angiographic Gore-Tex diameter/preoperative Gore-Tex diameter) between patients receiving ASA and those not receiving ASA. Motz et al 10 showed that ASA reduced the incidence of partial or complete shunt occlusion in a study of 37 infants (ASA, 13%; no ASA, 54%). This finding, however, was not confirmed in a larger study conducted by Al Jubair et al 5 of 546 shunts in 478 patients (ASA, 7%; no ASA, 11%; PϭNS).…”

Section: Discussionmentioning

confidence: 98%

“…[6][7][8] In addition, despite an overall reduction in mortality for single-ventricle palliation procedures in the current era, shunt thrombosis and interstage attrition remain significant problems. 9 Although the use of aspirin (ASA) was reported to reduce the rate of occlusion of aortopulmonary shunts in a small case series of 37 infants, 10 its efficacy was not confirmed in a larger study of 478 patients. 5 The purpose of the present study was to evaluate the morbidity and mortality of infants with systemic-to-pulmonary shunts and the effect of ASA use on these outcomes.…”

Section: Editorial P 236 Clinical Perspective P 297mentioning

confidence: 99%

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Clinical Outcomes of Palliative Surgery Including a Systemic-to-Pulmonary Artery Shunt in Infants With Cyanotic Congenital Heart Disease

et al. 2007

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Background-Aspirin (ASA) often is used to prevent thrombosis in infants with congenital heart disease after placement of a systemic-to-pulmonary artery shunt, but its effect on outcomes is unknown. Methods and Results-The present multicenter study prospectively collected data on 1-year postoperative rates of death, shunt thrombosis, or hospitalization age Ͻ4 months for bidirectional Glenn/hemi-Fontan surgery in 1004 infants. The use and dose of ASA were recorded. Kaplan-Meier event rates were calculated for each event and the composite outcome, and a Cox regression model was constructed for time to event. Model terms were ASA use and type of surgery, with adjustment for age at surgery. Diagnoses were hypoplastic left heart syndrome (nϭ346), tricuspid atresia (nϭ103), tetralogy of Fallot (nϭ127), pulmonary atresia (nϭ177), heterotaxy syndrome (nϭ38), and other (nϭ213

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Section: Discussionmentioning

confidence: 98%

Section: Editorial P 236 Clinical Perspective P 297mentioning

confidence: 99%

Clinical Outcomes of Palliative Surgery Including a Systemic-to-Pulmonary Artery Shunt in Infants With Cyanotic Congenital Heart Disease

et al. 2007

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“…In another, much smaller case study, aspirin was reported to decrease the incidence of stent thrombosis after MBTS surgery. 295 Mullen et al 296 …”

Section: 2-23 Renal Vein Thrombosis In Neonatesmentioning

confidence: 99%

Antithrombotic Therapy in Neonates and Children

Monagle

Chan

Goldenberg

et al. 2012

Chest

1,268

559

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“…Although antiplatelet therapy has been studied extensively in adults, evidence for its benefit in infants and young children is limited . While the use of aspirin was associated with a reduction in ECS thrombosis in some studies, others have failed to demonstrate a beneficial effect . In theory, aspirin alone may be insufficient to prevent arterial thrombosis because it inhibits only one pathway (cyclo‐oxygenase) of platelet activation, and would have minimal effect in treating thrombi that would be expected in ECS.…”

Section: Discussionmentioning

confidence: 99%

Prevention of Arteriovenous Shunt Occlusion Using Microbubble and Ultrasound Mediated Thromboprophylaxis

Kutty

Hammel

et al. 2014

JAHA

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BackgroundPalliative shunts in congenital heart disease patients are vulnerable to thrombotic occlusion. High mechanical index (MI) impulses from a modified diagnostic ultrasound (US) transducer during a systemic microbubble (MB) infusion have been used to dissolve intravascular thrombi without anticoagulation, and we sought to determine whether this technique could be used prophylactically to reduce thrombus burden and prevent occlusion of surgically placed extracardiac shunts.Methods and ResultsHeparin‐bonded ePTFE tubular vascular shunts of 4 mm×2.5 cm (Propaten; W.L Gore) were surgically placed in 18 pigs: a right‐sided side‐to‐side arteriovenous (AV, carotid‐jugular) shunt, and a left‐sided arterio‐arterial (AA, carotid‐carotid) interposition shunt in each animal. After shunt implantation, animals were randomly assigned to one of 3 groups. Transcutaneous, weekly 30‐minute treatments (total of 4 treatments) of either guided high MI US+MB (Group 1; n=6) using a 3% MRX‐801 MB infusion, or US alone (Group 2; n=6) were given separately to each shunt. The third group of 6 pigs received no treatments. The shunts were explanted after 4 weeks and analyzed by histopathology to quantify luminal thrombus area (mm2) for the length of each shunt. No pigs received antiplatelet agents or anticoagulants during the treatment period. The median overall thrombus burden in the 3 groups for AV shunts was 5.10 mm2 compared with 4.05 mm2 in AA (P=0.199). Group 1 pigs had significantly less thrombus burden in the AV shunts (median 2.5 mm2) compared with Group 2 (median 5.6 mm2) and Group 3 (median 7.5 mm2) pigs (P=0.006). No difference in thrombus burden was seen between groups for AA shunts.ConclusionTranscutaneous US with intravenous MB is capable of preventing thrombus accumulation in arteriovenous shunts without the need for antiplatelet agents, and may be a method of preventing progressive occlusion of palliative shunts.

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Reduced frequency of occlusion of aorto-pulmonary shunts in infants receiving Aspirin

Abstract: Aspirin reduced effectively the rate of occlusion of systemic-to-pulmonary arterial shunts, and should be continued as long as the shunt is in place.

Cited by 34 publications

References 11 publications

Clinical Outcomes of Palliative Surgery Including a Systemic-to-Pulmonary Artery Shunt in Infants With Cyanotic Congenital Heart Disease

Clinical Outcomes of Palliative Surgery Including a Systemic-to-Pulmonary Artery Shunt in Infants With Cyanotic Congenital Heart Disease

Antithrombotic Therapy in Neonates and Children

Prevention of Arteriovenous Shunt Occlusion Using Microbubble and Ultrasound Mediated Thromboprophylaxis

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