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Heparin-Coated Grafts Reduce Mortality in Pediatric Patients Receiving Systemic-to-Pulmonary Shunts

Adeel Ashfaq1, Mohammad S Soroya1, Amit Iyengar1

  • 1David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.

Pediatric Cardiology
|January 15, 2018
PubMed

Insights

Heparin-coated (HC) polytetrafluoroethylene (PTFE) vascular grafts significantly reduced shunt-related mortality and improved outcomes in pediatric patients undergoing systemic-to-pulmonary (SP) shunts compared to non-HC grafts.

Area of Science:

  • Cardiovascular Surgery
  • Pediatric Cardiology
  • Biomaterials Science

Background:

  • Systemic-to-pulmonary (SP) shunts are critical palliative procedures for complex congenital heart disease.
  • The choice of vascular graft material can influence shunt patency and patient outcomes.
  • Heparin-coated (HC) polytetrafluoroethylene (PTFE) grafts were introduced to potentially improve upon standard uncoated (non-HC) grafts.

Purpose of the Study:

  • To compare the efficacy and safety of HC PTFE grafts versus non-HC grafts in pediatric SP shunt procedures.
  • To evaluate the impact of HC grafts on perioperative outcomes, including morbidity, mortality, and blood product utilization.
  • To assess shunt patency and patient survival rates between the two graft types.

Main Methods:

  • Retrospective review of pediatric patients undergoing SP shunts between May 2008 and December 2015.
  • Comparison of outcomes between patients who received HC PTFE grafts (n=69) and those who received non-HC grafts (n=73).
  • Evaluation of perioperative variables: baseline characteristics, morbidity, mortality, blood product use, and shunt occlusion/thrombosis.

Main Results:

  • The HC graft group experienced significantly fewer desaturation or arrest events (P < 0.01) and shunt occlusions/thromboses (P < 0.01).
  • Significantly lower 30-day overall mortality (P < 0.01) and shunt-related mortality (P < 0.01) were observed in the HC group.
  • The HC group showed significantly reduced postoperative packed red blood cell utilization (P < 0.01) and maintained high graft patency.

Conclusions:

  • Heparin-coated PTFE grafts in pediatric SP shunts are associated with improved clinical outcomes and reduced shunt-related mortality.
  • HC grafts demonstrate enhanced efficacy, likely due to improved patency and reduced thrombotic events.
  • The findings suggest that HC PTFE grafts represent a beneficial advancement for pediatric patients requiring SP shunts.

Keywords:
Cardiac surgeryCongenital heart surgeryCyanotic heart diseaseShunts

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