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Ascending aorta to right pulmonary artery interposition shunt in critically ill infants
R M Kessler1, J A Wernly, B F Akl
1University of New Mexico, Division of Thoracic and Cardiovascular Surgery, Albuquerque 87131-5341.
Insights
The ascending aorta to right pulmonary artery (AA-RPA) shunt is a safe and effective palliative procedure for infants with complex cyanotic heart disease. This surgical technique demonstrates good shunt patency rates, offering a viable option for complex congenital heart conditions.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Surgery
- Vascular Surgery
Background:
- Complex cyanotic heart disease often necessitates interim palliation in neonates and infants.
- Systemic-to-pulmonary artery shunts are a common palliative approach.
- Earlier complete repair trends do not eliminate the need for shunting in select cases.
Purpose of the Study:
- To evaluate the efficacy and safety of the ascending aorta to right pulmonary artery (AA-RPA) interposition shunt.
- To assess the outcomes in very young infants with small vessels requiring palliation.
Main Methods:
- A retrospective review of 51 infants undergoing the AA-RPA interposition shunt over 15 years.
- Analysis of patient demographics (mean weight 3.33 kg, mean age 59 days).
- Evaluation of perioperative mortality and 2-year shunt patency rates.
Main Results:
- The AA-RPA shunt procedure was performed on 51 infants.
- Perioperative mortality was 13%.
- The overall shunt patency rate at 2 years was 78%.
Conclusions:
- The ascending aorta to right pulmonary artery (AA-RPA) interposition shunt is a safe and effective palliative option.
- This procedure is particularly effective in very young infants with small pulmonary arteries.
- The AA-RPA shunt offers a favorable patency rate for interim palliation in complex cyanotic heart disease.
Abstract:
In spite of a trend toward earlier complete repair, some neonates and infants with complex cyanotic heart disease continue to require interim palliation with systemic-to-pulmonary artery shunts. A variety of shunt procedures have been proposed, each with inherent advantages and disadvantages. We have found a prosthetic interposition shunt between the ascending aorta and right pulmonary artery (AA-RPA) to be effective in very young infants with small vessels. Over a 15-year period, 51 patients, mean weight 3.33 kg and mean age 59 days, underwent this procedure with a 13% perioperative mortality and a 78% 2-year overall shunt patency rate. We conclude that the AA-RPA interposition shunt is a safe, effective procedure in these infants.