Risk Factors for Early Shunt Dysfunction after Systemic-pulmonary Shunt_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

FANG Minhua , WANG Huishan , WANG Zengwei , ZHU Hongyu , WANG Zhenlong , ZHANG Chunzhen.

Department of Cardiovascular Surgery, General Hospital of Shenyang Military District, Shenyang 110016, P. R. China;

Corresponding author：

Keywords：

Systemic-pulmonary shunt; 　Shunt dysfunction; 　Risk factor

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Abstract：　Objective?To analyze the risk factors for early shunt dysfunction after systemic-pulmonary shunt in　order to improve early postoperative outcomes.　Methods　We retrospectively analyzed the clinical records of 189 patients　who underwent systemic-pulmonary shunt in General Hospital of Shenyang Military District between February 2002 and December 2010. There were 87 males and 102 females with their age ranging from 3 months to 50（5.3±6.2）years，and body weight ranging from 3 to 56（17.7±11.0）kg. There were 94 patients with tetralogy of Fallot （TOF） and pulmonary　artery stenosis，51 patients with pulmonary atresia （PA） and ventricular septal defect，4 patients with PA and intact ventricular septum，10 patients with functional single ventricle （SV） and pulmonary stenosis（PS），6 patients with SV and PA，6 patients with double outlet right ventricle and PS，8 patients with transposition of the great arteries（TGA） and PS，and 10 patients with TGA and PA. The surgical procedures included central aorto-pulmonary shunt （Waterston） in 105 patients, modified Blalock-Taussig shunt in 61 patients and Melbourne shunt in 23 patients.　Results　Early postoperative death occurred in 13 patients （6.9%）. There were 12 patients （6.3%） with intra-operative severe hypotension or arrhythmia, 10 patients （5.3%） with postoperative severe low cardiac output, and 10 patients （5.3%） with early shunt dysfunction within the first　24 h postoperatively. Univariate analysis identified low body weight （P=0.027）, shunt size with diameter＜4 mm （P=0.025） and severe intra-operative adverse event （hypotension or arrhythmia with P=0.002） were risk factors for early shunt dysfunction. In multivariate analysis, intra-operative adverse event was an independent risk factor for early shunt dysfunction（P=0.017）.　Conclusion　Early outcomes after systemic-pulmonary shunt can be significantly improved by preventing intra-operative severe hypotension or arrhythmia and choosing shunt size larger than 4 mm，especially for patients with young age, low body weight, and poorly-developed pulmonary artery.

Citation： FANG Minhua,WANG Huishan,WANG Zengwei,ZHU Hongyu,WANG Zhenlong,ZHANG Chunzhen.. Risk Factors for Early Shunt Dysfunction after Systemic-pulmonary Shunt. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2012, 19(4): 354-357. doi: Copy

1.	Cardiovasc Surg， 2008， 136 （2）：312-320.
2.	Yuan SM， Shinfeld A， Raanani E. The Blalock-Taussig shunt. J Card Surg， 2009， 24 （2）：101-108.
3.	Ballweg JA， Dominguez TE， Ravishankar C， et al. A contemporary comparison of the effect of shunt type in hypoplastic left heart syndrome on the hemodynamics and outcome at Fontan completion. J Thorac Cardiovasc Surg， 2010， 140 （3）：537-544.
4.	Pruetz JD， Badran S， Dorey F， et al. Differential banch pulmonary artery growth after the Norwood procedure with ventricular-pulmonary artery conduit versus modified Blalock-Taussig shunt in hypoplastic left heart syndrome. J Thorac Cardiovasc Surg， 2009， 137 （6）：1342-1348.
5.	Potapov EV， Alexi-Meskishvili VV， Dähnert I， et al. Development of pulmonary arteries after central aortopulmonary shunt in newborns. Ann Thorac Surg， 2001， 71 （3）：899-905.
6.	Mumtaz MA， Rosenthal G， Qureshi A， et al. Melbourne shunt promotes growth of diminutive central pulmonary arteries in patients with pulmonary atresia， ventricular septal defect， and systemic-to-pulmonary collateral arteries. Ann Thorac Surg， 2008， 85 （6）：2079-2083.
7.	Williams JA， Bansal AK， Kim BJ， et al. Two thousand Blalock-Taussig shunts：a six-decade experience. Ann Thorac Surg， 2007， 84 （6）：2070-2075.
8.	Ahmad U， Fatimi SH， Naqvi I， et al. Modified Blalock-Taussig shunt：immediate and short-term follow-up results in neonates. Heart Lung Circ， 2008， 17 （1）：54-58.
9.	Mohammadi S， Benhameid O， Campbell A， et al. Could we still improve early and interim outcome after prosthetic systemic-pulmonary shunt? A risk factors analysis. Eur J Cardiothorac Surg， 2008， 34 （3）：545-549.
10.	Wells WJ， Yu RJ， Batra AS， et al. Obstruction in modified Blalock shunts：a quantitative analysis with clinical correlation. Ann Thorac Surg， 2005， 79 （6）：2072-2076.
11.	O’Connor MJ， Ravishankar C， Ballweg JA， et al. Early systemic-to-pulmonary artery shunt intervention in neonates with congenital heart disease. J Thorac Cardiovasc Surg， 2011， 142 （1）：106-112.
12.	Gedicke M， Morgan G， Parry A， et al. Risk factors for acute shunt blockage in children after modified Blalock-Taussig shunt operations. Heart Vessels， 2010， 25 （5）：405-409.
13.	Batra AS， Starnes VA， Wells WJ. Does the site of insertion of a systemic-pulmonary shunt influence growth of the pulmonary arteries? Ann Thorac Surg， 2005， 79 （2）：636-640.
14.	Ohye RG， Gaynor JW， Ghanayem NS， et al. Design and rationale of a randomized trial comparing the Blalock-Taussig and right ventricle-pulmonary artery shunts in the Norwood procedure. J Thorac Cardiovasc Surg， 2008， 136 （4）：968-975.
15.	Bove EL， Migliavacca F， de Leval MR， et al. Use of mathematic modeling to compare and predict hemodynamic effects of the modified Blalock-Taussig hypoplastic left heart syndrome. J Thorac.
16.	Li JS， Yow E， Berezny KY， et al. Clinical outcomes of palliative surgery including a systemic-to-pulmonary artery shunt in infants with cyanotic　congenital heart disease：does aspirin make a difference? Circulation， 2007， 116 （3）：293-297.

1. Cardiovasc Surg， 2008， 136 （2）：312-320.
2. 　Yuan SM， Shinfeld A， Raanani E. The Blalock-Taussig shunt. J Card Surg， 2009， 24 （2）：101-108.
3. 　Ballweg JA， Dominguez TE， Ravishankar C， et al. A contemporary comparison of the effect of shunt type in hypoplastic left heart syndrome on the hemodynamics and outcome at Fontan completion. J Thorac Cardiovasc Surg， 2010， 140 （3）：537-544.
4. 　Pruetz JD， Badran S， Dorey F， et al. Differential banch pulmonary artery growth after the Norwood procedure with ventricular-pulmonary artery conduit versus modified Blalock-Taussig shunt in hypoplastic left heart syndrome. J Thorac Cardiovasc Surg， 2009， 137 （6）：1342-1348.
5. 　Potapov EV， Alexi-Meskishvili VV， Dähnert I， et al. Development of pulmonary arteries after central aortopulmonary shunt in newborns. Ann Thorac Surg， 2001， 71 （3）：899-905.
6. 　Mumtaz MA， Rosenthal G， Qureshi A， et al. Melbourne shunt promotes growth of diminutive central pulmonary arteries in patients with pulmonary atresia， ventricular septal defect， and systemic-to-pulmonary collateral arteries. Ann Thorac Surg， 2008， 85 （6）：2079-2083.
7. 　Williams JA， Bansal AK， Kim BJ， et al. Two thousand Blalock-Taussig shunts：a six-decade experience. Ann Thorac Surg， 2007， 84 （6）：2070-2075.
8. 　Ahmad U， Fatimi SH， Naqvi I， et al. Modified Blalock-Taussig shunt：immediate and short-term follow-up results in neonates. Heart Lung Circ， 2008， 17 （1）：54-58.
9. 　Mohammadi S， Benhameid O， Campbell A， et al. Could we still improve early and interim outcome after prosthetic systemic-pulmonary shunt? A risk factors analysis. Eur J Cardiothorac Surg， 2008， 34 （3）：545-549.
10. 　Wells WJ， Yu RJ， Batra AS， et al. Obstruction in modified Blalock shunts：a quantitative analysis with clinical correlation. Ann Thorac Surg， 2005， 79 （6）：2072-2076.
11. 　O’Connor MJ， Ravishankar C， Ballweg JA， et al. Early systemic-to-pulmonary artery shunt intervention in neonates with congenital heart disease. J Thorac Cardiovasc Surg， 2011， 142 （1）：106-112.
12. 　Gedicke M， Morgan G， Parry A， et al. Risk factors for acute shunt blockage in children after modified Blalock-Taussig shunt operations. Heart Vessels， 2010， 25 （5）：405-409.
13. 　Batra AS， Starnes VA， Wells WJ. Does the site of insertion of a systemic-pulmonary shunt influence growth of the pulmonary arteries? Ann Thorac Surg， 2005， 79 （2）：636-640.
14. 　Ohye RG， Gaynor JW， Ghanayem NS， et al. Design and rationale of a randomized trial comparing the Blalock-Taussig and right ventricle-pulmonary artery shunts in the Norwood procedure. J Thorac Cardiovasc Surg， 2008， 136 （4）：968-975.
15. 　Bove EL， Migliavacca F， de Leval MR， et al. Use of mathematic modeling to compare and predict hemodynamic effects of the modified Blalock-Taussig hypoplastic left heart syndrome. J Thorac.
16. 　Li JS， Yow E， Berezny KY， et al. Clinical outcomes of palliative surgery including a systemic-to-pulmonary artery shunt in infants with cyanotic　congenital heart disease：does aspirin make a difference? Circulation， 2007， 116 （3）：293-297.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Risk Factors for Early Shunt Dysfunction after Systemic-pulmonary Shunt

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