Abstract： Objective?To analyze the risk factors for early shunt dysfunction after systemic-pulmonary shunt in order to improve early postoperative outcomes. Methods We retrospectively analyzed the clinical records of 189 patients who underwent systemic-pulmonary shunt in General Hospital of Shenyang Military District between February 2002 and December 2010. There were 87 males and 102 females with their age ranging from 3 months to 50（5.3±6.2）years，and body weight ranging from 3 to 56（17.7±11.0）kg. There were 94 patients with tetralogy of Fallot （TOF） and pulmonary artery stenosis，51 patients with pulmonary atresia （PA） and ventricular septal defect，4 patients with PA and intact ventricular septum，10 patients with functional single ventricle （SV） and pulmonary stenosis（PS），6 patients with SV and PA，6 patients with double outlet right ventricle and PS，8 patients with transposition of the great arteries（TGA） and PS，and 10 patients with TGA and PA. The surgical procedures included central aorto-pulmonary shunt （Waterston） in 105 patients, modified Blalock-Taussig shunt in 61 patients and Melbourne shunt in 23 patients. Results Early postoperative death occurred in 13 patients （6.9%）. There were 12 patients （6.3%） with intra-operative severe hypotension or arrhythmia, 10 patients （5.3%） with postoperative severe low cardiac output, and 10 patients （5.3%） with early shunt dysfunction within the first 24 h postoperatively. Univariate analysis identified low body weight （P=0.027）, shunt size with diameter＜4 mm （P=0.025） and severe intra-operative adverse event （hypotension or arrhythmia with P=0.002） were risk factors for early shunt dysfunction. In multivariate analysis, intra-operative adverse event was an independent risk factor for early shunt dysfunction（P=0.017）. Conclusion Early outcomes after systemic-pulmonary shunt can be significantly improved by preventing intra-operative severe hypotension or arrhythmia and choosing shunt size larger than 4 mm，especially for patients with young age, low body weight, and poorly-developed pulmonary artery.
ObjectiveTo compare early clinical outcomes between systemic-pulmonary shunts (SPS) and right ventricular to pulmonary artery connection (RV-PA connection) for patients with pulmonary atresia and ventricular septal defect (PA/VSD), and investigate early management strategies for these 2 different palliative procedures. MethodsWe retrospectively analyzed clinical data of 89 PA/VSD patients who underwent SPS or RV-PA connection in Fu Wai Hospital from January 2009 to December 2011. According to different surgical procedures, all the 89 patients were divided into 2 groups. In SPS group, there were 59 patients including 35 males and 24 females with their median age of 25 months (4 months to 8 years). In RV-PA connection group, there were 30 patients including 19 males and 11 females with their median age of 24 months (28 days to 7 years and 2 months). Early clinical outcomes including mechanical ventilation time, length of ICU stay, morbidity, reexploration, improvement of oxygen saturation (SO2) and mortality were compared between the 2 groups. ResultsAmong 59 patients in SPS group, 3 patients (5.1%) died postoperatively. There was no in-hospital death among 30 patients in RV-PA connection group. The improvement of percentage of SO2 of RV-PA connection group was significantly higher than that of SPS group (31.7% vs. 22.2%, P < 0.05). There was no statistical difference in length of ICU stay (3.6±2.5 days vs. 4.2±5.1 days, P > 0.05), mechanical ventilation time (34.8±33.5 hours vs. 44.3±39.6 hours, P > 0.05), postoperative morbidity (37.3% vs. 30.0%, P > 0.05) or reexploration rate (15.3% vs. 6.7%, P > 0.05) between SPS group and RV-PA connection group. Incidence of serious postoperative complications of SPS group was signi-ficantly higher than that of RV-PA connection group (25.4% vs. 6.7%, P < 0.05). ConclusionEarly clinical outcomes of RV-PA connection is better than SPS for PA/VSD patients including greater SO2 improvement and lower mortality. Mid-term and long-term clinical results as well as larger study samples are needed for better evaluation.
ObjectiveTo analyze the clinical effects of staged repair for severe tetralogy of Fallot (TOF), and to investigate a better individual treatment of TOF. MethodsWe retrospectively analyzed the clinical data of 110 children with TOF in our hospital from January 2009 through December 2014. The patients were divided into a severe TOF group (Group A, n=23) and a mild TOF group (Group B, n=87). In the group A, all 23 patients underwent staged surgery (modified Blalock-Taussig and radical operation of TOF). In the Group B, all 87 patients only received a radical operation of TOF. The patients' preoperative and postoperative arterial oxygen saturation, McGoon ratio, left ventricular end-diastolic volume index (LVEDVI), the results of perioperation and follow-up were compared. ResultsIn the group A, there was no death after modified Blalock-Taussig (MBT). The median interval time between MBTs and radical operation was 9 months (ranged from 6.3 to 25.3 months). Compared with that before MBTs, the McGoon ratio and LVEDVI were significantly increased at the time of radical operation. And the pulmonary artery development and left ventricle volume reached the standard of radical operation of TOF (P < 0.01). After the radical operation, one patient died for pneumonia in the early postoperation period. In the group B, three patients died for low cardiac output syndrome during perioperation. There was no significant difference between the group A and the group B in in-hospital mortality, length of hospital stay, intensive care unit (ICU) stay, ventilation time, cardiopulmonary bypass time, aortic cross-clamp time, rate of using trans-annular repair path, or drainage of pleural fluid. ConclusionStaged repair of severe TOF is safe and effective for children, who are not suitable for one-stage radical operation. Severe TOF received staged repair can achieve the similar outcomes with that of mild TOF underwent one-stage radical operation.