title: Outcomes of systemic to pulmonary artery shunts in patients weighing less than 3 kg: analysis of shunt type, size, and surgical approach.
abstract: OBJECTIVE
  To evaluate outcomes of systemic to pulmonary artery shunts (SPS) in patients weighing less than 3 kg with regard to shunt type, shunt size, and surgical approach.
  
  
  METHODS
  Patients weighing less than 3 kg who underwent modified Blalock-Taussig or central shunts with polytetrafluoroethylene grafts at our institution from January 1, 2000, to May 31, 2011, were reviewed. Patients who had undergone other major concomitant procedures were excluded from the analysis. Primary outcomes included mortality (discharge mortality and mortality before next planned palliative procedure or definitive repair), cardiac arrest and/or extracorporeal membrane oxygenation (ECMO), and shunt reintervention.
  
  
  RESULTS
  In this cohort of 80 patients, discharge survival was 96% (77/80). Postoperative cardiac arrest or ECMO occurred in 6/80 (7.5%), and shunt reintervention was required in 14/80 (17%). On univariate analysis, shunt reintervention was more common in patients with 3-mm shunts (11/30, 37%) compared with 3.5-mm (2/36, 6%) or 4-mm shunts (1/14, 7%) (P < .003). There were no statistically significant associations between shunt type, shunt size, or surgical approach and cardiac arrest/ECMO or mortality. Multiple logistic regression demonstrated that a shunt size of 3 mm (P = .019) and extracardiac anomaly (P = .047) were associated with shunt reintervention, whereas no variable was associated with cardiac arrest/ECMO or mortality.
  
  
  CONCLUSIONS
  In this high-risk group of neonates weighing less than 3 kg at the time of SPS, survival to discharge and the next planned surgical procedure was high. Outcomes were good with the 3.5- and 4-mm shunts; however, shunt reintervention was common with 3-mm shunts.
authors.affiliation: Medical College of Wisconsin and the Herma Heart Center at the Children's Hospital of Wisconsin, Milwaukee, Wis.
authors.forename: John W
authors.initials: JW
authors.lastname: Myers
authors.affiliation: Medical College of Wisconsin and the Herma Heart Center at the Children's Hospital of Wisconsin, Milwaukee, Wis; Division of Critical Care in the Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wis.
authors.forename: Nancy S
authors.initials: NS
authors.lastname: Ghanayem
authors.affiliation: Medical College of Wisconsin and the Herma Heart Center at the Children's Hospital of Wisconsin, Milwaukee, Wis; Division of Quantitative Health Sciences in the Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wis; Division of Cardiothoracic Surgery in the Department of Surgery, Medical College of Wisconsin, Milwaukee, Wis.
authors.forename: Yumei
authors.initials: Y
authors.lastname: Cao
authors.affiliation: Medical College of Wisconsin and the Herma Heart Center at the Children's Hospital of Wisconsin, Milwaukee, Wis; Division of Quantitative Health Sciences in the Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wis; Department of Pediatrics, Medical College of Wisconsin, Medical College of Wisconsin, Milwaukee, Wis.
authors.forename: Pippa
authors.initials: P
authors.lastname: Simpson
authors.affiliation: Medical College of Wisconsin and the Herma Heart Center at the Children's Hospital of Wisconsin, Milwaukee, Wis.
authors.forename: Katie
authors.initials: K
authors.lastname: Trapp
authors.affiliation: Medical College of Wisconsin and the Herma Heart Center at the Children's Hospital of Wisconsin, Milwaukee, Wis; Division of Cardiothoracic Surgery in the Department of Surgery, Medical College of Wisconsin, Milwaukee, Wis.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Mitchell
authors.affiliation: Medical College of Wisconsin and the Herma Heart Center at the Children's Hospital of Wisconsin, Milwaukee, Wis; Division of Cardiothoracic Surgery in the Department of Surgery, Medical College of Wisconsin, Milwaukee, Wis.
authors.forename: James S
authors.initials: JS
authors.lastname: Tweddell
authors.affiliation: Medical College of Wisconsin and the Herma Heart Center at the Children's Hospital of Wisconsin, Milwaukee, Wis; Division of Cardiothoracic Surgery in the Department of Surgery, Medical College of Wisconsin, Milwaukee, Wis. Electronic address: rwoods@chw.org.
authors.forename: Ronald K
authors.initials: RK
authors.lastname: Woods
mesh_terms: D058366:Blalock-Taussig Procedure / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D001807:Blood Vessel Prosthesis; D001835:Body Weight; D016009:Chi-Square Distribution; D015199:Extracorporeal Membrane Oxygenation; D006330:Heart Defects, Congenital / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D011138:Polytetrafluoroethylene; D011183:Postoperative Complications / Q000401:mortality / Q000628:therapy; D011474:Prosthesis Design; D011651:Pulmonary Artery / Q000503:physiopathology / Q000601:surgery*; D011652:Pulmonary Circulation; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D011138:Polytetrafluoroethylene
keywords: 20; CPB; CS; ECMO; HIPAA; Health Insurance Portability and Accountability Act; MBTS; SPS; cardiopulmonary bypass; central shunt; extracorporeal membrane oxygenation; modified Blalock-Taussig shunt; systemic to pulmonary artery shunt