The clinical outcomes of systemic-pulmonary shunt in 92 patients / 中华胸心血管外科杂志

ABSTRACT

Objective:To analyse the clinical outcomes in patients after systemic-pulmonary shunt in order to improve the early and interim outcome and decrease the operative complications.Methods:Between June 2009 and December 2017, 92 patients with age from 3 months to 40 years, and weight from 3.5 to 60.0 kg, underwent a systemic-pulmonary shunt. Indications for surgical palliation were tetralogy of Fallot(TOF) in 31 patients, pulmonary atresia(PA)with ventricular septal defect with in 29 patients, PA with intact ventricular in 3 patients, functional single ventricle(SV)with pulmonary stenosis(PS) in 8 patients, double outlet right ventricle(DORV) with PS in 8 patients, transposition of the great arteries(TGA) with PS in 5 patients, TGA with PA in 3 patients, corrective transposition of the great arteries(ccTGA) with PA in 2 patients, the others in 3 patients. 30 patients were with PDA. The surgical procedure included modified Blalock-Taussig(B-T) shunt in 55 patients, central aortopulmonary shunt(Waterston)in 31 patients, and Melbourne shunt in 6 patients.Results:There were 7 early operative deaths, the early mortality was 7.6%. There were 9 patients with acute shunt blockage within the first 24 h, including TOF(2 patients), PA/VSD(4 patients), DORV/PS(1 patient), cCTGA/PA(1 patinet) and TA/PS(1 patinet). There was only 1 patient with acute shunt blockage after 2015. Overall , 48(48/85, 56.5%) patients were bridged to the comlpete repair or the second stage of Fontan operation. 7 patients were received the second shunt operations. 30 patients were still waiting for the next therapy.Conclusion:Systemic-pulmonary shunt is not a so-simple palliative procedure, the good early and interim outcome is associated with the choice of shunt method and perioperative treatment of complications.