2014, Number S2
<< Back Next >>
Rev Med Inst Mex Seguro Soc 2014; 52 (S2)
Mortality-associated factors in pediatric patients with Blalock-Taussig shunt
Aguilar-Segura PR, Lazo-Cárdenas C, Rodríguez-Hernández L, Márquez-González H, Giménez-Scherer JA
Language: Spanish
References: 21
Page: 62-67
PDF size: 70.69 Kb.
ABSTRACT
Background: Congenital heart disease with decreased pulmonary flow
survival has increased due to systemic pulmonary fistulae (SPF); nevertheless,
complications may occur. The purpose of this study was to identify
mortality-related surgical and biochemical factors in pediatric patients
with modified Blalock-Taussig shunt.
Methods: A cohort was formed with congenital heart disease newborns
who survived Blalock-Taussig-type palliative systemic pulmonary fistulae
surgery. At admission to the intensive care unit, surgical time, diameter
polytetrafl uoroethylene vascular graft, arterial blood gases and central
venous saturation were recorded. The patients were followed until discharge
or death. For statistical analysis, central tendency and dispersion
measures, chi-square tests, odds-ratios, Cox regression model and
hazard ratios (HR) were used, and for the most independent variable,
Kaplan-Meier curves.
Results: Out of 33 newborns who underwent the surgical procedure,
9 died (23%). The most common heart diseases were pulmonary atresia
with intact ventricular septum (8 patients, 25%) and hypoplastic right
ventricle (8, 25%). The most independent mortality-associated variable
was hyperlactatemia › 3 mmol/L (HR = 8 [1.9 - 32],
p ‹ 0.05).
Conclusions: Lactate › 3 mmol/L was an independent predictor of mortality
in patients who underwent Blalock-Taussig shunt.
REFERENCES
Calderón-Colmenero J, Cervantes-Salazar JL, Curi- Curi PJ, Ramírez-Marroquín S. Secuencia de estudio en el niño con cardiopatía congénita. PAC Pediatría I. México: Intersistemas; 2004. p. 504-605.
Samanek M. Congenital heart malformations: Prevalence, severity, survival and quality of life. Cardiol Young. 2000;10(3):179-85.
Mitchell SC, Korones SB, Berrendees HW. Congenital heart disease in 56,109 births. Incident and natural history. Circulation. 1971;43(2):323-32.
Calderón-Colmenero J, Ramírez MS, Cervantes SJ. Métodos de estratifi cación de riesgo en la cirugía de cardiopatías congénitas. Arch Cardiol Mex. 2008; 78(1):60-7.
Martínez OP, Romero C, Alzina AV. Incidencia de las cardiopatías congénitas en Navarra (1989-1998). Rev Esp Cardiol. 2005;58(12):1428-34.
Anderson RH, Weinberg PM. The clinical anatomy of tetralogy of Fallot. Cardiol Young. 2005;15(1):38-47.
Robert M, Freedom, Shi-Joon Yoo. Tetralogy of Fallot. En: Robert M, Freedom, Shi-Joo Yoo, Harverj M, editores. The natural and modifi ed history of congenial heart disease. First edition. Nueva York, EIA: Blackwell Publishing; 2004. p. 186-211.
Jubair KA, Fagih MR, Jarallah AS, Yousef S, Ali Khan MA, Ashmeg A, et al. Results of 546 Blalock- Taussig shunts performed in 478 patients. Cardiol Young. 1998;8(4):423-7.
Calderón-Colmenero J, Ramírez R, Viesca R, Ramírez L, Casanova M, García-Montes JA, et al. Cirugía de Fontan. Factores de riesgo a corto y mediano plazo. Arch Cardiol Mex. 2005;75(4):425-34.
Alkhulaifi AM, Lacour-Gayet F, Serraf A, Belli E, Planche’C. Systemic pulmonary shunts in neonates: Early clinical outcome and choice of surgical approach. Ann Thorac Surg. 2000;69(5);1499-504.
Daubeney PE, Daubeney PE, Wang D, Delany DJ, Keeton BR, Anderson RH, Slavik Z, et al. UK and Ireland Collaborative Study of Pulmonary Atresia with Intact Ventricular Septum: Predictors of early and medium-term outcome in a population-based study. J Thorac Cardiovasc Surg. 2005;130(2):1071-708.
Ashburn DA, Blackstone EH, Wells WJ, Jonas RA, Pigula FA, Manning PB. Congenital Heart Surgeons Study Members. Determinants of mortality and type of repair in neonates with pulmonary atresia and intact ventricular septum. J Thorac Cardiovasc Surg. 2004;127:1000-8.
Anderson RH, Anderson C, Zuberbuhler JR. Further morphologic studies on hearts with pulmonary atresia and intact ventricular septum. Cardiol Young. 1991;1:105-13.
Mohammadi S, Benhameid O, Campbell A, Potts J, Joza J, Al-Habib H, et al. Could we still improve early and interim outcome after prosthetic systemic-pulmonary shunt? A risk factors analysis. Eur J of Cardiothorac Surg. 2008;54(4):545-9.
Amigoni A, Mozzo E, Brugnaro L, Tiberio I, Pittarello D, Stellin G, et al. Four-side near-infrared spectroscopy measured in a pediatric population during surgery for congenital heart disease. Interact Cardiovasc Thorac Surg. 2011;12(5):707-12.
Karamlou T, Ashburn DA, Caldarone CA, Blackstone EH, Jonas RA, Jacobs ML, et al. Members of the Congenital Heart Surgeons’ Society. Matching procedure to morphology improves outcomes in neonates with tricuspid atresia. J Thorac Cardiovasc Surg. 2005;130(3):1503-10.
Kitaichi T, Chikugo F, Kawahito T, Hori T, Masuda Y, Kitagawa T. Suitable shunt size for regulation of pulmonary. blood fl ow in a canine model of univentricular parallel circulations. J Thorac Cardiovasc Surg. 2003;125(2):71-8.
Charpie JR, Dekeon MK, Goldberg CS, Mosca RS, Bove EL, Kulik TJ. Serial blood lactate measurements predict early outcome after neonatal repair or palliation for complex congental heart disease. J Thorac Cardiovasc Surg. 2000;120(1):73-80.
Alves RL, Aragão e Silva AL, Kraychete NC, Campos GO, Martins Mde J, Módolo NS. Intraoperative lactate levels and postoperative complications of pediatric cardiac surgery. Pediatric Anesthesia. 2012;22(8);812-7.
Centazzo S, Montigny M, Davignon A, Chartrand C, Fournier A, Marchand T. Use of acetylsalicylic acid to improve patency of subclavian to pulmonary artery Gore-Tex shunts. Can J Cardiol. 1993;9(3):243-6.
Li JS, Yow E, Berezny KY, Rhodes JF, Bokesch PM, Charpie JR, Forbus GA, et al. Outcomes of palliative surgery including a systemic-to-pulmonary artery shunt in infants with cyanotic congenital heart disease. Does aspirin make a difference? Circulation. 2007;116(3):293-7.