World journal for pediatric & congenital heart surgery最新文献

{"title":"Prognostic Nutritional Index (PNI) As a Preoperative Screening Tool in Predicting Clinical Outcomes of Postoperative Pediatric Cardiac Surgery Patients.","authors":"Satbir Kaur, Himani Pandya, Gargee Bhatt, Deepal Prajapati, Dhruvini Patel, Aparna Sirandas, Jigisha Pujara","doi":"10.1177/21501351241293998","DOIUrl":"10.1177/21501351241293998","url":null,"abstract":"<p><p>ObjectiveThe authors sought to evaluate the role of nutritional indices such as Onodera's prognostic nutrition index (PNI), World Health Organization (WHO)-based anthropometric measurements such as weight for age (w/a), height for age, weight for height, and perioperative serum albumin levels in the determination of postoperative clinical outcomes in pediatric patients who undergo surgery for congenital cardiac defects and surgical complexity (risk-adjusted congenital heart surgery score) and its correlation with postoperative course.Material and MethodsIn this prospective observational study, 108 post-pediatric cardiac surgery patients under the age of 18 months were enrolled between January 2023 and August 2023. Through receiver operating characteristic curve analysis we have found the cutoff value for PNI is ≤66.5 and >66.5. The above mentioned parameters were analyzed for postoperative clinical outcomes such as length of intensive care unit (ICU) stay, length of hospital stay, and duration of mechanical ventilation.ResultsSignificant negative correlation was found between length of ICU stay and hospital stay with lower PNI (<i>P</i> = .019 and <.001, respectively.). Analysis of low versus high PNI groups was suggestive of a remarkable increase in mechanical ventilation time (<i>P</i> = .03), length of ICU stay (0.01), and hospital stay (<i>P</i> ≤ .001) in the low PNI group. Lower WHO-based w/a Z score was found to be significantly associated with low PNI (<66.5), after adjusting for preoperative albumin, postoperative albumin drop, and C-reactive protein (odds ratio = 1.411 per unit 0.28 increment in W/azs, <i>P</i> = .004).ConclusionPreoperative Onoderas PNI is an effective and efficient tool for predicting postoperative clinical morbidity in pediatric patients undergoing congenital heart surgery.</p>","PeriodicalId":94270,"journal":{"name":"World journal for pediatric & congenital heart surgery","volume":" ","pages":"493-499"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143061922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical Repair of Tetralogy of Fallot With Pulmonary Atresia in Adults: Three Case Reports.","authors":"Benson Yuk Lun Chan, Tsz Him Ling","doi":"10.1177/21501351251322874","DOIUrl":"10.1177/21501351251322874","url":null,"abstract":"<p><p>We present three cases of adults who underwent late repair of tetralogy of Fallot with pulmonary atresia (ToF-PA). All three patients underwent palliative procedures at an earlier age and were not considered candidates for corrective surgery due to borderline pulmonary artery anatomy. They developed symptomatic decline with increasing dyspnea, desaturation, and decreasing exercise tolerance; thus, they were reconsidered for complete surgical repair of ToF-PA in adulthood. Improvement in symptoms and oxygen saturation were achieved in all patients. With advances in surgical techniques and cardiopulmonary bypass support, it may be worthwhile to review patients who underwent palliative procedures earlier in life but previously were thought not to be surgical candidates. The discussion for potential operative management of these patients may be possible aftercareful reassessment of pulmonary artery anatomy and ventricular function.</p>","PeriodicalId":94270,"journal":{"name":"World journal for pediatric & congenital heart surgery","volume":" ","pages":"553-557"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143702473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mid-Term Outcomes of Valve-Sparing Repair With Intraoperative Balloon Dilation in Tetralogy of Fallot.","authors":"Morgan K Moroi, Iris Feng, Alice V Vinogradsky, Christine G Yang, Stephanie N Nguyen, David M Kalfa, Andrew B Goldstone, Emile A Bacha","doi":"10.1177/21501351251321528","DOIUrl":"https://doi.org/10.1177/21501351251321528","url":null,"abstract":"<p><p>BackgroundLate sequelae associated with chronic severe pulmonary regurgitation (PR) following transannular patch (TAP) repair of tetralogy of Fallot (TOF) have driven the use of alternative approaches. This study investigates mid-term pulmonic valve (PV) durability in TOF patients who underwent valve-sparing repair with intraoperative balloon dilation (VS-IBD).MethodsBetween 2010 and 2022, 139 TOF patients underwent VS-IBD (n = 66) or TAP (n = 73) repair at a single institution. Patients who underwent VS repair without IBD were excluded. Baseline differences were balanced by inverse probability of treatment weighting (IPTW). Primary outcome was freedom from reintervention, with median follow-up of 4.6 years.ResultsValve-sparing repair with intraoperative balloon dilation patients were older (117 vs 64 days, <i>P</i> = .001) with higher PV annulus z-scores (-2.26 vs -2.62, <i>P</i> = .001) compared with TAP patients. After IPTW, VS-IBD patients had a higher reintervention rate (12.6% vs 2.2%, <i>P</i> = .028). At five years, 37/66 (56%) of VS-IBD patients remained free from ≥ moderate PR and 56/66 (85%) free from ≥ moderate pulmonic stenosis (PS). At the latest follow-up, VS-IBD patients demonstrated less right ventricular (RV) dilation (severe: 1.0% vs 15.5%, <i>P</i> = .002) and similar RV function (normal: 88.0% vs 91.8%, <i>P</i> = .273) as their TAP counterparts. In multivariable Cox analysis of VS-IBD patients, female sex (hazard ratio, HR [95% confidence interval, CI]: 4.4 [1.5, 13.2], <i>P</i> = .008) and preoperative PV z-score -2.67 to -2.18 (HR [95% CI]: 5.7 [1.6, 19.6], <i>P</i> = .006) were risk factors for developing ≥ moderate PR.ConclusionsDespite a higher early reintervention rate, the trade-off for VS-IBD patients appears to be better-preserved valve competency overall, as well as less adverse RV remodeling.</p>","PeriodicalId":94270,"journal":{"name":"World journal for pediatric & congenital heart surgery","volume":" ","pages":"21501351251321528"},"PeriodicalIF":0.0,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144183434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contemporary Approach to Managing Young Symptomatic Infants With Tetralogy of Fallot in the United Kingdom.","authors":"Ines Hribernik, Stacey Boardman, David Crossland, Antony Hermuzi, Hannah Bellsham-Revell, Patrick Elnazir, Andrew Ho, Norah Yap, Demetris Taliotis, Jack Gibb, James R Bentham","doi":"10.1177/21501351251322879","DOIUrl":"https://doi.org/10.1177/21501351251322879","url":null,"abstract":"<p><p>ObjectivesWe set out to determine the characteristics and outcomes of symptomatic infants with tetralogy of Fallot who due to insufficient pulmonary blood flow required transcatheter or surgical intervention in early infancy.MethodsFive centers in the United Kingdom contributed data for infants born with tetralogy of Fallot who underwent an initial procedure between January 2015 and January 2022. The studied group were infants requiring palliative or reparative procedure at less than three months of age. The primary outcome was survival to one year; secondary outcomes were periprocedural complications, cumulative mechanical ventilation time, length of hospital stay, and need for reintervention.ResultsA total of 535 infants with tetralogy of Fallot were identified during the study period. 96 infants underwent initial palliation (58 right ventricular outflow tract stent, 7 ductal stent, 17 balloon pulmonary valvuloplasty, 9 modified Blalock-Taussig-Thomas shunt, and 5 right ventricular outflow tract patch augmentation). 37 infants underwent primary repair at less than three months of age, 402 infants had primary repair at 3 to 12 months of age. Median age and weight were 26 days and 3.1 kg for initial palliation; 68 days and 4.7 kg for primary repair under three months (<i>P</i> < .001). One year survival post-procedure was 95.7% for initial palliation, and 97.3% for primary repair under three months (<i>P</i> = .55, hazard ratio [HR] 1.97, 95% confidence interval [CI] 0.33-11.67). Five-year freedom from reintervention on the right ventricle-to-pulmonary artery segment was 76% after staged repair and 88% after primary repair under three months (<i>P</i> = .23, HR 1.90, 95% CI 0.75-4.80).ConclusionsInitial palliation with staged repair remains the predominantly employed approach for the highest risk young infants with tetralogy of Fallot in the United Kingdom. Survival outcomes are excellent; concerns remain regarding increased cumulative costs and associated reintervention rates. Primary repair under three months of age has also proven to be feasible with excellent results, although with individual candidate selection bias.</p>","PeriodicalId":94270,"journal":{"name":"World journal for pediatric & congenital heart surgery","volume":" ","pages":"21501351251322879"},"PeriodicalIF":0.0,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144176297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence of Pulmonary Artery Interventions Following the Arterial Switch Operation.","authors":"Joshua D Kurtz, Yana Feygin, Samantha Stone, Deborah Kozik, Matt Hall, Michelle Stevenson","doi":"10.1177/21501351251329885","DOIUrl":"https://doi.org/10.1177/21501351251329885","url":null,"abstract":"<p><p>BackgroundPulmonary artery (PA) stenosis is a known complication of the arterial switch operation (ASO) for the repair of transposition of the great arteries. This has previously been described in small, single-center reports. This study aimed to examine the incidence of PA intervention and the impact of center volume in a large national sample.MethodsA multicenter, retrospective cohort study of infants undergoing neonatal ASO from January 2005 to December 2021 at hospitals in the Pediatric Health Information System database was performed. Primary outcomes were the overall prevalence of PA intervention and cumulative incidence rate by center volume tertile. A Cox proportional hazard model clustered by center and partitioned at 1.5 years, assessed the impact of volume on intervention rates.Results7411 infants underwent ASO; 1262 (17%) had a PA intervention. The median time to intervention was 0.8 years. Those who underwent intervention had longer initial hospital length of stay (22 vs 18 days, <i>p</i> < .01), lower birth weight (3000 gm vs 3150 g, <i>p</i> < .01), and were more likely to have a ventricular septal defect (59.3% vs 43.6%, <i>p</i> < .01). The incidence of PA intervention differed significantly by center volume over time with hazard ratios of 2.14 (95% CI, 1.71-2.69) and 1.32 (95% CI, 1.04-1.68) for the lowest and middle volume tertile compared with the highest volume tertile, respectively.ConclusionsPA intervention is common after ASO with the majority occurring in the first year. Larger volume centers had lower intervention rates. Studies are needed to identify modifiable factors to decrease PA intervention rates.</p>","PeriodicalId":94270,"journal":{"name":"World journal for pediatric & congenital heart surgery","volume":" ","pages":"21501351251329885"},"PeriodicalIF":0.0,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transposition of the Great Arteries With Intact Ventricular Septum and Left Ventricular Outflow Tract Obstruction: An Analysis of The Society of Thoracic Surgeons Congenital Heart Surgery Database (STS-CHSD).","authors":"Husain Esmaeil, Jeffrey Phillip Jacobs, Mark Steven Bleiweis, James D St Louis, Niharika Parsons, James K Kirklin, David M Overman, Vladimiro L Vida, Andrzej Kansy, Bohdan Maruszewski, Zdzislaw Tobota, Claudia Cattapan, Awais Ashfaq, Zohair Al-Halees, George E Sarris, Marshall Lewis Jacobs, Christo I Tchervenkov","doi":"10.1177/21501351251329911","DOIUrl":"https://doi.org/10.1177/21501351251329911","url":null,"abstract":"<p><p>PurposeTransposition of the great arteries with intact ventricular septum and left ventricular outflow tract obstruction (TGA + IVS + LVOTO) is a rare congenital cardiac malformation. This study aims to describe the operations performed for patients with TGA + IVS + LVOTO in the Society of Thoracic Surgeons Congenital Heart Surgery Database (STS-CHSD) and review their short-term outcomes.MethodsA total of 112 patients with the diagnosis of TGA + IVS + LVOTO in the STS-CHSD who underwent cardiac surgery between January 1999 and June 2021 were included. Patients' characteristics, operative data, and postoperative outcomes were analyzed.ResultsA total of 120 index cardiac operations were performed. The most common operations were the arterial switch procedure (n = 33), Glenn/HemiFontan (n = 10), Fontan (n = 9), Rastelli with ventricular septal defect (VSD) creation (n = 6), Damus-Kaye-Stansel procedure (n = 5), heart transplant (n = 5), and atrial switch (n = 4). Concomitant repair of subvalvar aortic stenosis was coded in 7 of 33 patients undergoing the arterial switch operation. The overall operative mortality was 4.5% (5 deaths in 112 patients undergoing 120 index cardiac operations). The overall major complication rate was 19% (23 of 120 cases). Major complications occurred in 9 of 33 (27%) of the arterial switch operations. The most common complications were unplanned reoperation in 14 of 120 cases (12%) arrhythmias requiring pacemaker implantation in 5 of 120 (4.2%), and postoperative mechanical circulatory support in 4 of 120 (3.3%).ConclusionThe diagnosis of TGA + IVS + LVOTO is rare in the STS-CHSD. The most common procedures performed for this disease were the arterial switch operation (often with concomitant repair of subvalvar aortic stenosis), Rastelli with VSD creation, and palliative functionally univentricular operations.</p>","PeriodicalId":94270,"journal":{"name":"World journal for pediatric & congenital heart surgery","volume":" ","pages":"21501351251329911"},"PeriodicalIF":0.0,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144153289","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes After Surgery for Isolated Rheumatic Aortic Valve Disease in the Young: Preoperative Left Ventricular Dysfunction is a Risk Factor for Increased Mortality.","authors":"Hilary A Hardefeldt, Steven Kiyokawa, Thomas L Gentles, Ajay J Iyengar, Bryan Mitchelson, Dug Yeo Han, Kirsten Finucane, Nigel J Wilson","doi":"10.1177/21501351251339390","DOIUrl":"https://doi.org/10.1177/21501351251339390","url":null,"abstract":"<p><strong>Background: </strong>To improve understanding of indications and outcomes for cardiac surgery for rheumatic aortic valvular disease in the young.</p><p><strong>Methods: </strong>Single institution retrospective cohort aged < 18 years with rheumatic heart disease who underwent surgery for isolated rheumatic aortic valve disease between 2000 and 2019. Baseline, intermediate follow-up, and late follow-up data were collected. Left ventricular (LV) dysfunction defined as LV ejection fraction < 55% or LV shortening fraction < 27%.</p><p><strong>Results: </strong>Thirty-nine patients who were 8 to 18 years of age were included (median age 14 years), weighing 27 to 157 kg (median 78 kg) with follow up of 2 to 15 years (median 7 years). Index operations were valve repair 6 of 39 (15%), valve replacement 33 of 39 (84%) with homograft (n = 20), and mechanical valve (13). The 30-day mortality was zero. Overall mortality was 8 of 39 (20%); 17 of 39 (43%) underwent reoperation. At intermediate and late follow up, 27% (7/26) and 53% (18/34) had persistent dysfunction, respectively. Baseline LV dysfunction increased the risk of death (hazard ratio 13.3 [1.52-115.5], <i>P</i> = .003), which increased adjusting for higher body surface area (BSA). All those with baseline weight > 105 kg either died or had LV dysfunction at late follow up (<i>P</i> = .001). Freedom from late valve-related complications at 5, 10, and 15 years was 72%, 31%, and 23%, respectively.</p><p><strong>Conclusions: </strong>Preoperative LV dysfunction is associated with an increased risk of death for pediatric patients undergoing isolated rheumatic aortic valve surgery. This risk increases further, adjusting for BSA. There was a high rate of reoperations and late complications.</p>","PeriodicalId":94270,"journal":{"name":"World journal for pediatric & congenital heart surgery","volume":" ","pages":"21501351251339390"},"PeriodicalIF":0.0,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144153288","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Favorable Vessel Patency Following Carotid Artery Reconstruction During Extracorporeal Membrane Oxygenation Decannulation in Children With Congenital Heart Disease.","authors":"Ariya Chau, Shiraz A Maskatia, Basma Albuliwi, Elisabeth Martin, Kathleen R Ryan","doi":"10.1177/21501351251338830","DOIUrl":"https://doi.org/10.1177/21501351251338830","url":null,"abstract":"<p><p>BackgroundCarotid artery ligation has been a common practice after extracorporeal membrane oxygenation (ECMO) decannulation due to the risks of embolization, cerebral infarction, aneurysm, and stenosis over time. Carotid artery reconstruction (CAR) after ECMO decannulation is increasingly used, though studies report variable stenosis rates. Data on CAR in children with heart disease, who may require carotid artery patency for future surgery or repeat ECMO, are lacking.ObjectiveTo evaluate carotid artery patency and the incidence of cerebral infarction in pediatric cardiac patients after CAR and ECMO decannulation.MethodsA retrospective review of children (0-21 years of age) who required venoarterial extracorporeal membrane oxygenation (VA-ECMO) via neck cannulation in the cardiovascular intensive care unit at a quaternary children's hospital (2015-2022) was conducted. Children who underwent CAR and survived to discharge were included.ResultsFifty-three children (ages 2 days to 21 years, median, 2 years of age) met the study criteria. Carotid artery imaging was performed in 25 children (47%), with 84% (21/25) showing unobstructed arteries. Imaging follow-up ranged from two days to four years, with a median of three months. Of 33 children who had post-ECMO head imaging, 11 showed new cerebral infarcts, with 4 of those infarcts diagnosed following transition to ventricular assist device (VAD). Given the variability of timing and modality of head imaging and the significant proportion of patients on a VAD, we are unable to determine the true incidence of new infarcts following CAR.ConclusionCarotid artery reconstruction after VA-ECMO decannulation in children with congenital heart disease shows early favorable vessel patency, but the long-term neurological benefits compared with ligation remain unclear. Further prospective studies are needed to evaluate long-term patency and neurological outcomes.</p>","PeriodicalId":94270,"journal":{"name":"World journal for pediatric & congenital heart surgery","volume":" ","pages":"21501351251338830"},"PeriodicalIF":0.0,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144129932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical Intervention in Pediatric Marfan Syndrome: A Multiinstitutional Study.","authors":"Mario O'Connor, Andrew Well, Maria E Hoyos, Catherine E Stauber, Charles D Fraser, Hugo Martinez","doi":"10.1177/21501351251335474","DOIUrl":"https://doi.org/10.1177/21501351251335474","url":null,"abstract":"<p><p>BackgroundIndividuals with Marfan syndrome (MFS) are at risk for the development of cardiovascular complications. Although the majority of MFS patients do not require cardiac surgery until adulthood, cardiovascular disease in the pediatric MFS population is still notable.MethodsThis is a retrospective of the Pediatric Health Information System from January 2004 to December 2023. All patients <18 years of age with a diagnosis of MFS who underwent aortic (Ao) and/or mitral valve (MV) surgery were included.ResultsA total of 343 patients were identified, with 115 (34%) females, 190 (55%) White non-Hispanic, and a median age of 13.0 [interquartile range (IQR): 9.0-16.0] years at surgery. Among the cohort, 241/343 (70%) underwent an aortic procedure, 40/343 (12%) aortic + MV procedure, and 62/343 (18%) MV procedure. Median hospital length of stay was 6.0 [IQR: 5.0-9.5] days, 9/343 (3%) patients required extracorporeal membrane oxygenation, and 4/343 (1%) died in-hospital. Freedom from any reintervention at 15 years was 48.8% (95% CI: 34.0-70.0). Multivariable Cox regression analysis revealed that older age at the time of surgery was associated with a reduced risk of reintervention (hazard ratio: 0.94; 95% CI: 0.89-0.99, <i>p</i> = 0.023). The overall survival rate at 15 years was 94.2% (95% CI: 90.5-98.0), and no factors were associated with increased mortality.ConclusionsOperations for cardiovascular complications of MFS can be performed safely in appropriately selected children with low morbidity and mortality and with good short-term and long-term outcomes. These findings support the safety and efficacy of surgical intervention in this population.</p>","PeriodicalId":94270,"journal":{"name":"World journal for pediatric & congenital heart surgery","volume":" ","pages":"21501351251335474"},"PeriodicalIF":0.0,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144083121","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes and Predictors of Failure of Systemic-to-Pulmonary Shunts: Experience of a Single Institution Over 14 Years.","authors":"Hannah O Davis, Michael Johansen, Mark D Rodefeld, Mark W Turrentine, John W Brown, Jeremy L Herrmann","doi":"10.1177/21501351251335646","DOIUrl":"https://doi.org/10.1177/21501351251335646","url":null,"abstract":"<p><p>BackgroundSystemic artery-to-pulmonary artery (SA-PA) shunts provide effective palliation for complex congenital heart disease (CHD) but carry a risk for morbidity and mortality. We aimed to comprehensively analyze our experience with SA-PA shunts.MethodsOur institutional Society of Thoracic Surgeons (STS) database was queried to identify patients who underwent SA-PA shunts from 2009 to 2022, excluding those who underwent the Norwood procedure, right ventricle-PA shunt, or fenestrated patch. Definitions from the STS Congenital Heart Surgery Database Specifications were used. Shunt failure included dysfunction secondary to thrombosis, obstruction, stenosis, or outgrowth requiring intervention.ResultsA total of 287 patients met inclusion criteria. Shunts were placed at a median of 15.0 days (interquartile range 7.0-39.5). A thoracotomy approach was used in 178 out of 287 patients (62.0%), and cardiopulmonary bypass was employed in only 46 of 287 cases (16.0%). Survival to the next stage was 89.5% (246/275), with in-hospital mortality of 6.3% (18/287) and interstage mortality of 4.2% (12/287). Shunt failure occurred in 54/287 (18.8%), and 77/287 (26.8%) required reintervention for shunt-related complications. On multivariable analysis, poorer shunt failure-free survival was associated with any syndrome, left-sided arch vessel shunt origin, concurrent complex repairs, competitive flow from a patent ductus arteriosus, and delayed antiplatelet initiation. The thoracotomy approach was protective. Risk factors for worse survival to the next stage included shunt thrombosis and perioperative platelet transfusion.ConclusionsWhile complications remain common, our contemporary results demonstrate that SA-PA shunts remain a reliable palliation for CHD with insufficient pulmonary blood flow. Risk reduction may involve careful management of competitive pulmonary blood flow and prompt initiation of antiplatelet therapy.</p>","PeriodicalId":94270,"journal":{"name":"World journal for pediatric & congenital heart surgery","volume":" ","pages":"21501351251335646"},"PeriodicalIF":0.0,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144083120","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}