Early systemic-to-pulmonary artery shunt intervention in neonates with congenital heart disease

Objective To determine the incidence, risk factors, and outcomes after early, unplanned intervention on systemic-to-pulmonary artery shunts in neonates. Methods We retrospectively studied all neonates undergoing systemic-to-pulmonary artery shunt placement at The Children’s Hospital of Philadelphia between September 1, 2002, and May 1, 2005. Patients requiring transcatheter or surgical systemic-to-pulmonary artery shunt intervention before discharge were compared with those not undergoing shunt intervention. Results A total of 206 patients underwent shunt placement. Diagnoses included hypoplastic left heart syndrome (62.1%), pulmonary atresia (15%), tricuspid atresia (4.9%), tetralogy of Fallot (2.4%), and other lesions with obstruction to systemic (10.7%) or pulmonary blood flow (4.9%). Twenty-one interventions occurred in 20 patients (9.7%). Risk factors for intervention included heterotaxy syndrome ( P = . 04), congenital abnormality ( P = . 04), and a trend toward lower birthweight. In patients with a modified Blalock–Taussig shunt, similar risk factors were identified and the incidence of intervention decreased with increasing shunt size. In-hospital mortality was 30% (6/20) for the cases and 8.1% (15/186) for the nonintervention group ( P = . 02). Long-term survival was significantly lower in patients requiring intervention ( P = . 002). This group also had a higher incidence of infections ( P