Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.
Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Eur J Cardiothorac Surg. 2021 Jul 30;60(2):377-383. doi: 10.1093/ejcts/ezab077.
To investigate risk factors for mortality after systemic-to-pulmonary (SP) shunt procedures in patients with a functionally univentricular heart using the Japan Cardiovascular Surgery Database registry.
Clinical data from 75 domestic institutions were collected. Overall, 812 patients with a functionally univentricular heart who underwent initial SP shunt palliation were eligible for analysis. Patients with pulmonary atresia with an intact ventricular septum and patients with a SP shunt as part of the Norwood procedure were excluded. Risk factors for 30- and 90-day mortalities were analysed using a logistic regression model.
Median age and body weight at SP shunt placement were 41 days and 3.6 kg, respectively. Modified Blalock-Taussig shunt, central shunt and other types of SP shunts were applied in 689 (84.9%), 94 (11.8%) and 30 (3.7%) patients, respectively. Cardiopulmonary bypass was utilized in 410 patients (51%) for 128 min (median, 19-561). There were 411 isolated SP shunt procedures. Median hospital stay was 27 days, and 742 (91.4%) patients were discharged. The 30- and 90-day mortality rates were 3.4% and 6.0%, respectively. Placement of a central shunt was identified as a risk factor for 30-day mortality, while lower body weight, preoperative ventilator support, right atrial isomerism and coexistence of major aortopulmonary collateral arteries and an unbalanced atrioventricular septal defect were identified as risk factors for 90-day mortality.
SP shunt carries a high mortality rate in patients with a functionally univentricular heart when it is performed in smaller patients with complex cardiac anomalies.
利用日本心血管外科学数据库登记系统，调查功能性单心室患者行体肺（SP）分流术后死亡的危险因素。
收集了 75 家国内机构的临床数据。共有 812 例功能性单心室患者行初始 SP 分流姑息术，符合分析条件。排除了单纯性肺动脉瓣闭锁伴完整室间隔和作为 Norwood 手术一部分的 SP 分流术患者。使用逻辑回归模型分析 30 天和 90 天死亡率的危险因素。
SP 分流术时的中位年龄和体重分别为 41 天和 3.6kg。改良 Blalock-Taussig 分流术、中央分流术和其他类型的 SP 分流术分别在 689（84.9%）、94（11.8%）和 30（3.7%）例患者中应用。410 例（51%）患者采用体外循环，体外循环时间为 128min（中位数，19-561）。有 411 例孤立的 SP 分流术。中位住院时间为 27 天，742 例（91.4%）患者出院。30 天和 90 天的死亡率分别为 3.4%和 6.0%。中央分流术的放置被确定为 30 天死亡率的危险因素，而体重较轻、术前呼吸机支持、右心房异构和大主肺动脉侧支血管并存以及房室间隔缺损不平衡是 90 天死亡率的危险因素。
在体型较小且合并复杂心脏畸形的功能性单心室患者中，行 SP 分流术时死亡率较高。
