Ashfaq Adeel, Soroya Mohammad S, Iyengar Amit, Federman Myke, Reemtsen Brian L
David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
Mattel Children's Hospital, Los Angeles, CA, USA.
Pediatr Cardiol. 2018 Mar;39(3):473-477. doi: 10.1007/s00246-017-1776-5. Epub 2018 Jan 13.
We aimed to evaluate the outcomes of systemic-to-pulmonary (SP) shunt procedures utilizing heparin-coated (HC) polytetrafluoroethylene (PTFE) vascular grafts compared to uncoated (non-HC) grafts, in order to observe any benefits in pediatric patients. Our institution switched from using non-HC grafts to HC grafts in March 2011. We conducted a retrospective review of consecutive pediatric patients receiving SP shunts from May 2008 to December 2015. Perioperative variables including baseline characteristics, morbidity, mortality, and blood product utilization were evaluated between the HC and non-HC groups. A total of 142 pediatric patients received SP shunts during the study period: 69 patients received HC shunts and 73 patients received non-HC shunts. The HC group had significantly fewer desaturation or arrest events (P < 0.01), fewer shunt occlusions/thromboses (P < 0.01). There was no statistically significant difference in unplanned reoperations between groups (P = 0.18). The HC group demonstrated significantly lower overall 30-day mortality (P < 0.01), as well as shunt-related mortality (P < 0.01). The HC group had significantly lower postoperative packed red blood cell utilization as compared to the non-HC group (P < 0.01). In this study, pediatric patients receiving HC PTFE grafts in SP shunts demonstrated significantly lower shunt-related mortality. The majority of HC grafts remained patent. These findings suggest that HC grafts used in SP shunt procedures may benefit pediatric patients in terms of efficacy and outcomes.
我们旨在评估使用肝素涂层（HC）聚四氟乙烯（PTFE）血管移植物进行体肺分流术（SP）与未涂层（非HC）移植物相比的效果，以观察对儿科患者是否有任何益处。我们机构于2011年3月从使用非HC移植物改为使用HC移植物。我们对2008年5月至2015年12月期间接受SP分流术的连续儿科患者进行了回顾性研究。评估了HC组和非HC组之间的围手术期变量，包括基线特征、发病率、死亡率和血液制品使用情况。在研究期间，共有142名儿科患者接受了SP分流术：69名患者接受了HC分流术，73名患者接受了非HC分流术。HC组的去饱和或心脏骤停事件明显较少（P < 0.01），分流闭塞/血栓形成较少（P < 0.01）。两组之间计划外再次手术无统计学显著差异（P = 0.18）。HC组的30天总体死亡率明显较低（P < 0.01），以及分流相关死亡率也较低（P < 0.01）。与非HC组相比，HC组术后红细胞压积的使用明显较低（P < 0.01）。在本研究中，接受HC PTFE移植物进行SP分流术的儿科患者的分流相关死亡率明显较低。大多数HC移植物保持通畅。这些发现表明，用于SP分流术的HC移植物在疗效和结果方面可能使儿科患者受益。
