Vitanova Keti, Leopold Cornelius, Pabst von Ohain Jelena, Wolf Cordula, Beran Elisabeth, Lange Rüdiger, Cleuziou Julie
Department of Cardiovascular Surgery, German Heart Centre Munich, Technische Universität München, Lazarettstrasse 36, 80636, Munich, Germany.
Insure (Institute for Translational Cardiac Surgery), Department of Cardiovascular Surgery, German Heart Centre Munich, Technische Universität München, Munich, Germany.
Pediatr Cardiol. 2018 Oct;39(7):1323-1329. doi: 10.1007/s00246-018-1898-4. Epub 2018 May 14.
Systemic-to-pulmonary artery shunt placement is an established palliative procedure for congenital heart disease, but it is associated with high morbidity and mortality. Data of all patients with biventricular circulation who underwent systemic-to-pulmonary artery shunt implantation between 2000 and 2016 were reviewed. Endpoints of the study were shunt failure and shunt-related mortality. Shunt failure was defined as any shunt dysfunction requiring intervention or reoperation. Shunt-related mortality was defined as death due to shunt dysfunction. A total of 217 shunts (central shunt, n = 131, Blalock-Taussig shunt, n = 86) were implanted in 178 patients. The median age of the patients was 98 days [1 day to 1.2 years]. Corrective surgery was performed at a median time of 0.6 years [3 months to 7 years] after shunt placement. Shunt failure was diagnosed in 21 patients (9.6%) at a median time of 14.6 days [0 days to 2 years]. Causes of shunt failure were stenosis (n = 11; 5%) and thrombosis (n = 10; 4.6%). The rate of freedom from shunt failure was 89.9 ± 2.6% at 1 year, the rate of shunt-related mortality was 3% (n = 5), and the rate of freedom from shunt-related mortality at 1 year was 97.5 ± 1%. Platelet transfusion was required in 43 patients (20%), all for postoperative thrombocytopenia. Perioperative platelet transfusion (p = 0.03) and shunt size of 3 mm (p = 0.03) were identified as risk factors for shunt failure. Shunt size of 3 mm was also identified as a risk factor for shunt-related mortality. The ideal shunt size in patients with biventricular circulation requiring a systemic-to-pulmonary artery shunt is 3.5 mm or larger. Platelet transfusion increases the risk of shunt failure and should be avoided. Type of shunt and diagnosis have no influence on morbidity or mortality after shunt placement.
体-肺动脉分流术是一种针对先天性心脏病的成熟姑息性手术，但它与高发病率和死亡率相关。回顾了2000年至2016年间接受体-肺动脉分流植入术的所有双心室循环患者的数据。该研究的终点是分流失败和分流相关死亡率。分流失败定义为任何需要干预或再次手术的分流功能障碍。分流相关死亡率定义为因分流功能障碍导致的死亡。178例患者共植入217个分流装置（中央分流，n = 131；Blalock-Taussig分流，n = 86）。患者的中位年龄为98天[1天至1.2岁]。在分流术后中位时间0.6年[3个月至7年]进行矫正手术。21例患者（9.6%）被诊断为分流失败，中位时间为14.6天[0天至2年]。分流失败的原因是狭窄（n = 11；5%）和血栓形成（n = 10；4.6%）。1年时无分流失败的发生率为89.9±2.6%，分流相关死亡率为3%（n = 5），1年时无分流相关死亡率的发生率为97.5±1%。43例患者（20%）需要输注血小板，均因术后血小板减少。围手术期输注血小板（p = 0.03）和3mm的分流尺寸（p = 0.03）被确定为分流失败的危险因素。3mm的分流尺寸也被确定为分流相关死亡率的危险因素。对于需要体-肺动脉分流术的双心室循环患者，理想的分流尺寸为3.5mm或更大。输注血小板会增加分流失败的风险，应避免。分流类型和诊断对分流术后的发病率或死亡率没有影响。
