Risk of Early Shunt Failure for Children with Congenital Heart Disease

Which Children with CHD Are at Highest Risk of Early Shunt Failure?

Published on in CHOP News

Because in-hospital shunt failure is common among children with congenital heart disease (CHD), a CHOP researcher investigated risk factors for this potentially catastrophic complication. Nhue Do, MD, a Cardiology Fellow at Children’s Hospital of Philadelphia analyzed data from a large multicenter clinical registry, the Society of Thoracic Surgeons Congenital Heart Surgery Database (STS-CHSD).

Dr. Do and colleagues investigated records for over 9,100 infants from 118 centers who underwent shunt operations (systemic artery-to-pulmonary artery or systemic ventricle-to-pulmonary artery) from 2010 to 2015, presenting results recently at the Society for Thoracic Surgeons meeting in Phoenix.

In-hospital shunt failure occurred in 674 (7.3 percent) of the 9,172 infants, all younger than 1 year old. Risk factors for in-hospital shunt failure included lower weight at operation, preoperative hypercoagulable state, and the presence of any other STS-CHSD preoperative risk factors. Patients with in-hospital shunt failure had significantly higher rates of operative mortality, greater morbidity, and longer median post-operative length of stay among survivors. Shunt failure was less likely with systemic ventricle-to-pulmonary artery shunt than with systemic artery-to-pulmonary artery shunt. Neither cardiopulmonary bypass nor single ventricle diagnosis were risk factors for shunt failure.

These data highlight at-risk patients and procedural cohorts that warrant expectant surveillance,” says Dr. Do. “Further studies are needed to characterize this subset of patients that may benefit from enhanced anti-thrombotic prophylaxis or other management strategies to reduce shunt failure.”

Contact: Joey McCool Ryan, The Children’s Hospital of Philadelphia, 267-426-6070 or mccool@email.chop.edu