Open Access

ARTICLE

Analysis of Risk Factors for Early Mortality in Surgical Shunt Palliation: Time for a Change?

by François-Xavier Van Vyve¹, Karlien Carbonez², Jelena Hubrechts², Geoffroy de Beco¹, Jean E. Rubay¹, Mona Momeni³, Thierry Detaille⁴, Alain J. Poncelet^1,*

1 Department of Cardiovascular and Thoracic Surgery, Université catholique de Louvain (UCLouvain)-Cliniques Universitaires Saint-Luc, Brussels, Belgium
2 Department of Pediatric Cardiology, Université catholique de Louvain (UCLouvain)-Cliniques Universitaires Saint-Luc, Brussels, Belgium
3 Department of Anesthesiology, Université catholique de Louvain (UCLouvain)-Cliniques Universitaires Saint-Luc, Brussels, Belgium
4 Department of Pediatric Intensive Care, Université catholique de Louvain (UCLouvain)-Cliniques Universitaires Saint-Luc, Brussels, Belgium

* Corresponding Author: Alain J. Poncelet. Email:

Congenital Heart Disease 2023, 18(5), 539-550. https://doi.org/10.32604/chd.2023.042344

Received 26 May 2023; Accepted 05 September 2023; Issue published 10 November 2023

Abstract

Objectives: Over the last decade, neonatal repair has been advocated for many congenital heart diseases. However, specific subgroups of complex congenital heart disease still require temporary palliation for which both surgical and endovascular techniques are currently available. We reviewed our institutional experience with shunt palliation with an emphasis on risk factors for early mortality. Methods: This is a single-center retrospective study on 175 patients undergoing surgery for central shunt or modified Blalock-Taussig shunt. All data were extracted from a prospectively collected computerized database. We identified risk factors for early mortality by uni- and multi-variable analysis. All data were censored at the time of death or shunt take-down operation. Results: Mean age and weight at surgery were 24 days (IQR [7–95]) and 3.4 kg (IQR [2.9–4.8]), respectively, with 96 neonates (55%). Most patients had a biventricular heart disease (115 patients, 66%), and 51 patients (29.1%) had univentricular heart disease. Thoracotomy was performed in 129 patients (74%). Cardiopulmonary bypass was used in 23 patients (13%). The median intensive care and overall length of stay were 4 days (IQR [2–9]) and 18 days (IQR [13–29]), respectively. In-hospital mortality was 8.6% (15/175). By multivariable regression analysis, prematurity (HR 5.6 [2.1–14.7]), CPB use (HR 6.7 [2.2–18.6]), unplanned <30-day reoperation (HR 3.5 [1.2–10]) or catheterization (HR 4.5 [1.2–16.9]) were all significant predictors of early mortality. Conclusions: Procedural-related mortality remains high (8.6%) in surgical shunt palliation. For patients with prematurity, low weight at birth, or if the use of cardiopulmonary bypass is contemplated, alternative endovascular techniques of palliation should be considered together with longitudinal follow-up studies.

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Supplementary Material

Supplementary Material File

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