Defining the best practice patterns for the neonatal systemic-to-pulmonary artery shunt procedure

Abstract

A substantial variation was found between hospitals in the rate of shunt-related complications. Centers with best outcomes implement aspirin earlier in their postoperative shunt thrombosis prophylaxis regimen.

The effects of postoperative hematocrit on shunt occlusion for neonates undergoing single ventricle palliation

“…32 A national database study examining best practices associated with systemic-to-pulmonary artery shunts found no difference in the use of postoperative heparin between centers with low or high incidences of shunt failure. 33 These studies did not consider differences in postoperative hematocrit. Large-scale, thoughtful investigations are clearly needed to determine the best perioperative management.…”

Extracorporeal membrane oxygenator support in infants with systemic-pulmonary shunts

“…Patient populations receiving SP shunts have changed considerably over the past 70 years, 7,8 but the rate of in-hospital mortality has changed little, from 8.1% in the earliest reports 9 to 4% to 10% in the higher-risk contemporary populations. 8,10,11 Major morbidity also remains common with SP shunts, with reintervention required in 7.3% of recipients and 3% to 6% requiring ECMO support.…”

“…Patient populations receiving SP shunts have changed considerably over the past 70 years, 7,8 but the rate of in-hospital mortality has changed little, from 8.1% in the earliest reports 9 to 4% to 10% in the higher-risk contemporary populations. 8,10,11 Major morbidity also remains common with SP shunts, with reintervention required in 7.3% of recipients and 3% to 6% requiring ECMO support. 11,12 We have analyzed a consecutive series of 169 infants and neonates requiring mechanical circulatory support in the form of veno-arterial ECMO, to ascertain the impact on outcomes of the presence of an SP shunt during ECMO support.…”

P2Y12 Receptor Function and Response to Cangrelor in Neonates With Cyanotic Congenital Heart Disease

“…In particular, those with single-ventricle physiology who require placement of a systemic-to-pulmonary artery shunt (e.g., modified Blalock-Taussig or central shunts) are at greatest risk, especially in the early post-operative period 3 , 4 , 5 . Consequently, this scenario has resulted in suboptimal post-operative outcomes as exemplified in a retrospective review of 2,058 neonates who underwent palliation with a systemic-to-pulmonary artery shunt at multiple centers; discharge mortality and complication rates were around an aggregate of 6.7% and 12.3%, respectively (6) . Early institution of aspirin, an irreversible inhibitor of platelet cyclooxygenase, is believed to be beneficial in reducing the risk of shunt occlusion and death 7 , 8 , but controversy remains regarding its overall effectiveness.…”