ISSN : 1301-5680
e-ISSN : 2149-8156
Turkish Journal of Thoracic and Cardiovascular Surgery     
Systemic-to-pulmonary shunt operation in neonates with ductus-dependent pulmonary blood flow
Ersin Erek1, Yusuf Kenan Yalçınbaş 1, Yasemin Mamur 1, Ece Salihoğlu 1, Tamer Turan 1, Ayşe Çolakoğlu 3, Ayşe Sarıoğlu 2, Tayyar Sarıoğlu1
1Departments of Cardiovascular Surgery, Acıbadem Bakırköy Hospital, İstanbul
2Departments of Pediatric Cardiology, Acıbadem Bakırköy Hospital, İstanbul
3Departments of Anesthesiology, Acıbadem Bakırköy Hospital, İstanbul
Background: Systemic-to-pulmonary arterial (S-P) shunts are among the major strategies for palliation of cyanotic neonates with critical pulmonary stenosis or atresia. We evaluated early and mid-term results of S-P shunt operations performed in neonates.

Methods: Systemic-to-pulmonary shunt operations were performed in 25 neonates (mean age 13.5±6.4 days; range 1 to 25 days) with cyanotic congenital heart disease and ductus- dependent pulmonary blood flow. The smallest neonate weighed 1500 grams. Median sternotomy was performed in all but two patients who underwent a left thoracotomy. Shunt anastomoses included the ascending aorta to the main pulmonary (n=8) or right pulmonary (n=8) arteries, or the brachycephalic artery to the right pulmonary (n=7) artery. Graft size was 3.5 mm for the ascending aorta and 4 mm for the brachycephalic artery. The mean follow-up period was 24 months (range 3 to 54 months).

Results: In-hospital mortality occurred in six patients (24%) due to sudden cardiac arrest (n=2) and sepsis (n=4). Shuntrelated complications developed in five patients (20%). Three sudden deaths occurred after 9, 12, 17 months, respectively. Four corrective and three palliative operations were performed. The remaining patients were in good clinical condition and were followed-up for further treatment. Emergent operation was found to be a significant predictor for in-hospital mortality (p<0.05). None of the risk factors were significantly associated with shunt failure. Actuarial one- and three-year survival rates were 93% and 74%, respectively.

Conclusion: Systemic-pulmonary shunt operation in the neonatal period is a complex procedure, with considerable mortality and morbidity. Satisfactory mid-term palliation can be obtained with median sternotomy, but close followup of patients including early elective palliation or correction is mandatory due to high incidence of sudden death.

Keywords : Anastomosis, surgical; heart defects, congenital; infant, newborn; palliative care; pulmonary artery/surgery
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