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Surgical outcomes of the systemic-to-pulmonary artery shunt: risk factors of post-operative acute events and effectiveness of regulation of pulmonary blood flow with metal clips

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Abstract

Objectives

The aim of this study was to analyze the risk factors for acute events after systemic-to-pulmonary shunt (SPS) and to investigate the effectiveness of pulmonary blood flow regulation with a metal clip.

Methods

The case histories of 116 patients (78 biventricular [BV] and 38 single ventricle [SV] physiology) who underwent SPS between 2010 and 2021 were retrospectively reviewed. Our strategy was to delay SPS until 1 month of age; pulmonary blood flow (PBF) regulation by partial clipping of the graft, if needed. Cases of aortic cross-clamping were excluded from this study.

Results

CPB was used in 49 (42%) patients: the median age at SPS was 1 month (2 days to 16 years), and the sternotomy approach in 65. Discharge survival was 98.3% (114/116); hospital death occurred in 1.7% due to coronary ischemia. Inter-stage mortality occurred in 1.7% (shunt thrombosis, 1; pneumonia, 1). Pre-discharge acute events occurred in 7 patients (6.0%): thrombosis 3, pulmonary over-circulation 2, and coronary ischemia 2. Multiple logistic regression analysis revealed that pulmonary atresia with intact ventricular septum (PA/IVS) (p = 0.0253) was an independent risk factor for acute events. Partial clipping of the graft was performed in 24 patients (pulmonary atresia 15) and clip removal was performed by catheter intervention in 9 patients; no coronary ischemic events and graft injury occurred in these patients.

Conclusion

Surgical outcomes after SPS were acceptable and metal clip regulation of pulmonary blood flow appears to be safe and effective. PA/IVS was still a significant risk factor for acute events.

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Data availability

All patients were selected by the search term BTS or CS in the database of all patients with consultancy in Niigata University Hospital. Patient’s names were anonymized and each were given an unique code, which cannot be traced back. All data were collected in an encrypted excel file, only accessible for the authors. The data underlying this article cannot be shared publicly due to privacy of the patients and will only be shared on reasonable request to the corresponding author.

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Authors and Affiliations

  1. Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-Dori, Chuo-Ku, Niigata, Japan

    Shuichi Shiraishi, Maya Watanabe, Ai Sugimoto & Masanori Tsuchida

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  1. Shuichi Shiraishi
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  2. Maya Watanabe
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  3. Ai Sugimoto
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  4. Masanori Tsuchida
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Correspondence to Shuichi Shiraishi.

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Shiraishi, S., Watanabe, M., Sugimoto, A. et al. Surgical outcomes of the systemic-to-pulmonary artery shunt: risk factors of post-operative acute events and effectiveness of regulation of pulmonary blood flow with metal clips. Gen Thorac Cardiovasc Surg (2024). https://doi.org/10.1007/s11748-024-02028-8

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