Contemporary Outcomes of Systemic-to-Pulmonary Shunt in Patients With Congenital Heart Disease: A Single-Center Retrospective Study.

Abstract

Systemic-to-pulmonary shunt (SPS) remains an essential palliative procedure for congenital heart disease. We assessed contemporary outcomes after SPS. We retrospectively reviewed 565 patients who underwent SPS with expanded polytetrafluoroethylene grafts between 2008 and 2023. Patients were stratified into 3 surgical eras to evaluate temporal trends: era 1, 2008-2013; era 2, 2014-2018; and era 3, 2019-2023. Median age and body weight at SPS were 25 days and 3.44 kg, respectively. Target operations (TOs) were achieved in 478 patients (84.6%): biventricular repair (n = 272), bidirectional Glenn shunt (n = 178), one-and-a-half ventricle repair (n = 24), and transition to other types of palliation (n = 4). Loss to follow-up occurred in 15 patients; SPS remained in situ without further treatment in 3 patients. Mortality before TO occurred in 69 patients (12.4%), including 24 early deaths (4.6%). Pre-TO survival at 6 months improved significantly across eras, from 83% in era 1 to 94% in era 3 (P = .007). On logistic regression, early mortality was associated with a functionally single ventricle (odds ratio [OR], 3.13; P = .02), lower body weight at SPS (OR, 4.17; P = .002), and a sternotomy approach (OR, 21.75; P = .003). On Cox regression, pre-TO overall mortality was associated with a functionally single ventricle (hazard ratio [HR], 3.19; P < .001), pulmonary atresia (HR, 1.79; P = .04), pre-SPS cardiac surgery (HR, 2.40; P = .04), concomitant cardiovascular procedures at SPS (HR, 2.08; P = .004), and larger graft diameter to body weight ratio (HR, 1.13; P = .05). A higher dose aspirin protocol was protective (HR, 0.54; P = .02). Outcomes after SPS have improved in the contemporary era, likely reflecting advances in perioperative management.