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Risk Factors for Failure of Systemic-to-Pulmonary Artery Shunts in Biventricular Circulation
Keti Vitanova1,2, Cornelius Leopold3,4, Jelena Pabst von Ohain3,4
1Department of Cardiovascular Surgery, German Heart Centre Munich, Technische Universität München, Lazarettstrasse 36, 80636, Munich, Germany. vitanova@dhm.mhn.de.
Systemic-to-pulmonary artery shunt placement for congenital heart disease can lead to failure or death. Using a shunt size of 3.5 mm or larger and avoiding platelet transfusions can improve outcomes.
Area of Science:
- Cardiology
- Pediatric Surgery
- Congenital Heart Disease
Background:
- Systemic-to-pulmonary artery shunt placement is a palliative procedure for congenital heart disease.
- This procedure is associated with significant morbidity and mortality.
Purpose of the Study:
- To evaluate shunt failure and shunt-related mortality in patients with biventricular circulation.
- To identify risk factors influencing shunt outcomes.
Main Methods:
- Retrospective review of 217 systemic-to-pulmonary artery shunts implanted between 2000 and 2016.
- Analysis of endpoints including shunt failure (dysfunction, intervention, reoperation) and shunt-related mortality.
Main Results:
- Shunt failure occurred in 9.6% of patients, primarily due to stenosis (5%) and thrombosis (4.6%).
- The 1-year freedom from shunt failure was 89.9%, and 1-year freedom from shunt-related mortality was 97.5%.
- Perioperative platelet transfusion and a shunt size of 3 mm were identified as risk factors for shunt failure and mortality.
Conclusions:
- An ideal shunt size of 3.5 mm or larger is recommended for systemic-to-pulmonary artery shunts in biventricular circulation.
- Platelet transfusion should be avoided to minimize the risk of shunt failure.
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