Shunt occlusion in children with congenital heart disease undergoing systemic-pulmonary shunt: an analysis of risk factors and early and mid-term results / 中华胸心血管外科杂志

ABSTRACT

Objective To determine the early and mid-term outcomes of shunt occlusion in infant and children after systemic-pulmonary shunt surgery and explore the risk factors of shunt occlusion in these patients.Methods Retrospective analysis was conducted for 295 patients with congenital heart disease after systemic pulmonary shunt surgery at Fuwai Hospital from January 2010 to August 2016.There were 183 males and 112 females with their median age 7.5 months,and mean body weight (9.2 ±4.9) kg.The major cardiac diagnosis included pulmonary atresia and ventricular septal defect(110 cases),transposition of the great arteries (67 cases),tetralogy of Fallot (38 cases) and others.The surgical procedures included central aorto-pulmonary shunt in 97 patients and modified Blalock-Taussig shunt in 198 patients.The outcomes were compared between patients with and without shunt occlusion group and risk factors were identified using univariate and multivariate logistic analysis.Results Death occurred in 25 patients in which 16％ were associated with shunt occlusion.Follow-up was complete in 92.2％ averaging 35 months(range 2 to 84 months).Multivariate logistic regression analysis identified that the central aorto-pulmonary shunt type(P =0.008),shunt size less than 4 mm(P =0.001),platelet transfusion(P =0.001) and poor compliance for aspirin antiplatelet therapy(P =0.04) were all the independent risk factors despite adjusting for other variables.While the increased postoperative oxygen saturation may be the protective factor(OR =0.93,P =0.001).Conclusion The central aortopulmonary shunt type,smaller shunt size,platelet transfusion,decreased postoperative oxygen saturation and poor compliance for ASA antiplatelet therapy were important factors of shunt occlusion in patients undergoing shunt surgery.The proper identification and management would improve the prognosis of these patients.