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