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THE JOURNAL OF CARDIOVASCULAR SURGERY

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The Journal of Cardiovascular Surgery 2000 February;41(1):23-30

lingua: Inglese

Outcome of patients with cyanotic congenital heart disease undergoing a second systemic-to-pulmonary artery shunt

Aeba R., Katogi T., Takeuchi S., Kawada S.

From the Divi­sion of Car­di­o­vas­cular Sur­gery Keio Uni­ver­sity, ­Tokyo, ­Japan


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Back­ground. Mul­tiple ­systemic-to-pul­mo­nary ­artery ­shunts ­often rep­re­sent a devi­a­tion ­from the ­initial man­age­ment ­strategy for cya­notic con­gen­ital ­heart dis­ease. ­This ­study ana­lysed the out­come in ­patients under­going a ­second ­shunt.
­Methods. ­Between 1965 and 1998, 80 ­patients ­required a ­second ­shunt. ­Patient age ­ranged ­from 11 ­days to 11.2 ­years at the ­initial ­shunt, and 4 ­months to 25.6 ­years at the ­second ­shunt. The ­interval ­between ­shunts ­ranged ­from 11 ­days to 19.6 ­years.
­Results. The ­patient sur­vival ­rates at 1, 6, 12, 60 and 120 ­months fol­lowing the ­second ­shunt ­were 95.0±2.4%, 92.5±3.0%, 87.4±3.7%. 82.4±4.5% and 74.8±5.8%, respec­tively. ­Although ­excess pul­mo­nary ­flow was not encoun­tered ­after the ­second ­shunt, ­mode and inci­dence of mor­bidity ­were oth­er­wise sim­ilar to the ­first one. ­Between 9 ­months and 7.5 ­years ­after the ­second ­shunt, 24 ­patients under­went suc­cessful defin­i­tive ­repair. Mul­ti­var­i­able anal­ysis iden­ti­fied pul­mo­nary ­atresia (p=0.027) and a ­short (<1 ­year) ­interval ­between the two ­shunts (p=0.034) as the inde­pen­dent ­risk fac­tors for ­long-­term ­shunt ­failure. ­Single ven­tricle phys­iology (p=0.002) and a cen­tral ­approach for the ­second ­shunt (p=0.016) ­were inde­pen­dent ­risk fac­tors for ­lack of appli­ca­tion, or ­failure of intra­car­diac defin­i­tive ­repair.
Con­clu­sions. A sig­nif­i­cant lim­i­ta­tion in lon­gevity and ­quality of ­life is ­common in ­patients ­requiring a ­second ­shunt, espe­cially ­those asso­ciated ­with pul­mo­nary ­atresia, the ­single ven­tricle phys­iology ­heart, or ungraft­ably hypo­plastic con­tra­lat­eral ­branch pul­mo­nary ­artery to the ­first ­shunt. ­Since ­excess pul­mo­nary ­blood ­flow ­leading to con­gen­ital ­heart ­failure and/or ven­tric­ular dia­stolic dys­func­tion is ­unlikely, all ­patients who pre­clude defin­i­tive ­repair due to ­decreased pul­mo­nary ­blood ­flow ­even ­after the ­first ­shunt ­should be ­shunted ­again.

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